Services under the compulsory medical insurance policy, compulsory medical insurance, free services, what services are included in the policy

A compulsory health insurance policy (abbreviated compulsory medical insurance) allows you to check the services that a health care institution has provided to you. All citizens of Russia have a compulsory medical insurance policy - it provides access to free medical insurance services, which are guaranteed by the law “On the fundamentals of protecting the health of citizens of the Russian Federation” (Federal Law No. 323 of November 21, 2011).

Article 91 of this law provides for the possibility of checking the composition and quality of individual services and procedures. The ability to control the services provided makes it possible to challenge poor-quality medical care, including with the help of a lawyer.

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Services under compulsory medical insurance policy

Having a compulsory medical insurance policy guarantees unhindered receipt of free, qualified medical care without unexpected financial costs. Presentation of the document is a mandatory condition when applying to any hospital or clinic in the Russian Federation. In the absence of a policy, medical services will also be provided, but on a paid basis.

The basic compulsory medical insurance program includes primary health care, preventive services, and emergency medical care. There is a separate list of services that are provided on a preferential basis or completely free of charge.

How to check the types of medical care provided?

With the development of the State Services portal, there is no longer any need to make a request to the insurance company. This service provides access to the “Personal Account of the Insured Person,” which stores electronic documents about the services provided to the person under the compulsory medical insurance policy.

In the “Personal Account” you can check information not only about the services provided by clinics and hospitals, but also about their cost, that is, about the amount that the doctor and honey receive for serving you as a patient. institution. Thus, the portal's capabilities are quite extensive. Let's look at them in more detail.

How to use your personal account on State Services?

Insurance companies that issue a compulsory medical insurance policy to a citizen process all services provided in the field of free medicine and provide this data to the State Services portal. On this portal, information about all operations using the compulsory medical insurance policy is processed in accordance with the “Law on the Protection of Personal Data” (Federal Law No. 152 of July 27, 2006) and is provided only to the patient himself. The following information is stored in your personal account:

personal data of the insured person: full name, region of residence, number of the issued policy, patient contacts, number of the clinic where he usually receives medical services;
information about existing chronic and previously suffered diseases, injuries, and other indicators affecting health (blood type, identified allergic reactions, etc.);
types of services that the patient received under the compulsory health insurance policy from January 2015 to the present, as well as their cost.

This information is presented in the form of an extract for the period you select. We especially note that information about services for the period before 2015 is not provided in most cases. However, in some regions - for example, in Moscow - the digitization of patient information began before 2015, so information about the medical care provided in an earlier period may be available in the “Personal Account of the Insured Person”.

You can check information about the services provided to you in four steps.

Go to the “My Health” page on “State Services”.
Click on the “Information about medical care provided” tab.
Log in to State Services.
Order a statement for the period you need.

For greater user convenience, in the “Popular Services” section, you can view information about being assigned to a medical institution, about the services provided and their cost, information about the insurance policy and the company that issued it, about the medical and social examination of people with disabilities. To do this, select the appropriate section and follow the link.

In addition, through State Services you can apply to be assigned to another clinic or change insurance company, as well as call a doctor at home. In addition, this electronic service provides the opportunity to plan your treatment. You can use the calendar of events and receive a reminder about your upcoming visit to a medical facility by email.

Access to the “Personal Account of the Insured Person” is also provided by territorial compulsory medical insurance portals (the so-called TFOMS), where you can find expanded information about the services under the policy provided to a patient living in this region. You can check whether there is a TFOMS in your region on the official portal.

Compulsory medical insurance policy free services

Types of medical services that are provided free of charge based on the compulsory medical insurance policy:

Oncological and dental treatment in accordance with the list of the Russian Health Committee.
Fluorogram for preventive purposes due to the need to detect tuberculosis in the early stages.
Preventing common diseases with vaccines.
Provision of medications and preferential prosthetics.
Assistance in outpatient and inpatient settings.

What about them?

In France, treatment is paid for using a special compulsory health insurance card - Carte Vitale. Doctor's services are covered by the state by 70-100%, medicines by 15-100%.
Approximately 600 thousand Swedish citizens use private VHI policies, which are paid for by the employer.
95% of China's population has health insurance, but it does not cover most hospital services. Treating a serious illness can bankrupt the average family.
10% of Americans do not have health insurance - these US citizens can only count on free treatment in emergency cases.
In Japan, health insurance is compulsory, with citizens covering about 30% of the cost of treatment themselves.
About 85% of the German population prefers to use the services of private insurance companies. For the poor, the policy is paid for by the state.

What services are included in the compulsory medical insurance policy?

Today, the list of medical care items provided under the compulsory medical insurance policy also includes dental treatment.

The following list of free services is provided:

Primary consultation and examination. This item also includes care for patients who are unable to move independently.
Work on drawing up a map of diseases and the features of their elimination.
Treatment of periodontitis, periodontal diseases, pulpitis and caries. Elimination of problems with the mucous membrane and oral cavity, removal of foreign bodies and treatment of other injuries.
Reduction of dislocations, operations on soft tissues, removal of malignant tumors and teeth that cannot be restored.

Advice from Sravni.ru:
The terms of the contract that is signed upon receipt of the compulsory medical insurance policy are standard in nature, since they were developed by the director of the Federal Compulsory Medical Insurance Fund A.M. Taranov. in instructions No. 3856/30-3/i dated October 3, 2003. Each health insurance contract is formed taking into account the provisions of the above-mentioned document. Otherwise, the agreement may be declared invalid. The signing of the agreement is aimed at preventing a number of conflict situations. The document also helps to clearly define the existing areas of responsibility of the parties.

Comparative characteristics of both systems

Compulsory medical insurance	VHI
Conditions	The state determines the choice; the client cannot influence the choice.	Determined by the insurer, the client chooses a package of services.
Services	Standard set, regional authorities may expand the list.	Several options at different prices.
Choosing a clinic	Any government You can change clinics no more than once a year.	Depends on the selected insurance package.
Price	For free.	From 20 thousand and above.
Source of financing	Employer contributions, state budget.	Personal income or employer contribution.
Visit to the doctor	As usual - by appointment or live queue.	There is priority in service.
Standard tests and studies	Covered by the policy.	There may be restrictions on the number of treatments in a given time.
Specialized analyzes and studies	By doctor's direction or for an additional fee. In the first case, a long wait is possible.	As directed by a doctor. May be paid or free depending on the selected program.
Hospitalization	Provided.	Depends on the terms of the program.
Vaccination	Provided.
Specific treatment	By general queue or by quotas.
Rehabilitation	By general queue or by quotas.
Treatment of chronic diseases	Provided.
Individual conditions	No.

What documents are needed for vaccination?

To carry out vaccination you will need a passport and compulsory medical insurance policy.

How to sign up for vaccination?

The vaccine is supplied to medical organizations in all constituent entities of the Russian Federation. The list of medical organizations where you can get vaccinated can be found on the website of the Ministry of Health of a constituent entity of the Russian Federation.

You can sign up through the State Services portal: open the vaccination registration form, select the vaccination point and a convenient date and time. If there are no available seats, the waitlist button will become active. Employees of the medical organization will call you to invite you for vaccination and agree on a convenient date and time.

To receive the service, you will need a compulsory medical insurance policy, a contact phone number and SNILS - it is necessary to obtain an electronic certificate for State Services.

Registration is also possible using a single number 122 (not available in all regions).

In addition, vaccination points are also being deployed in large shopping centers, in MFCs, and in mobile points where they accept people without an appointment.

Is a medical examination carried out before vaccination?

Yes, everyone who comes for vaccination undergoes a preliminary medical examination.

Who can get vaccinated?

Any citizen who has a compulsory medical insurance policy, is over 18 years of age, has not had ARVI two weeks before vaccination, is not sick at the time of vaccination, and has not had contact with someone sick with coronavirus infection for the last two weeks can get vaccinated.

How is the procedure done?

The vaccine is administered twice with an interval of two to three weeks (depending on the vaccine chosen). So that you do not forget about the second injection, you will receive an SMS reminder. If you received your first vaccination in another region, you can receive the second dose of the vaccine in Moscow.

Is it possible to get vaccinated against coronavirus infection immediately after recovery for those who have already had COVID-19?

It is recommended to get vaccinated approximately six months after recovery.

Is self-isolation necessary before or after getting vaccinated against coronavirus?

No, you can lead a normal life. But don’t forget about precautions: social distancing and wearing a mask in public places.

How to get revaccinated against COVID-19

According to the methodological recommendations of the Russian Ministry of Health, repeated vaccination of citizens against coronavirus is allowed

For those who were ill more than six months ago, doctors recommend vaccination. Revaccination can be done with the Sputnik Light vaccine.

Where can you get re-vaccination https://www.mos.ru/city/projects/covid-19/covidvaccine/

How to sign up for vaccination in Moscow?

You can get vaccinated by appointment at one of 100 points at city clinics. If you are assigned to a medical institution, you can register online on the mos.ru and EMIAS portals. If you do not have an attachment or compulsory medical insurance policy, sign up for vaccination by phone.

You can get vaccinated without an appointment at points where mobile teams work.

Also in Moscow, it is possible to undergo the second stage of vaccination for residents of other regions, having previously made an appointment by phone at one of the clinics.

More detailed information on vaccination in Moscow can be found at https://www.mos.ru/city/projects/covid-19/privivka/

Is Moscow registration required for vaccination in Moscow?

No. Any adult citizen with a passport and compulsory health insurance policy can get vaccinated at the points where the field teams work.

How to sign up for vaccination in the Moscow region?

Vaccination against coronavirus infection can be done in city clinics, MFCs, some shopping centers, as well as in mobile points. Some vaccination sites in the region are open 24 hours a day. You can find out more about the list of vaccination points on the map https://covid.mz.mosreg.ru/.

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Date modified: 12/23/2021 16:55:36