What you need to know about the compulsory medical insurance policy so that it brings maximum benefit

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

The document even allows treatment for free in some private clinics.

1. Almost everyone can get a policy

Compulsory medical insurance policy is a document that confirms that you are included in the compulsory health insurance system and have the right to free medical care. And of all kinds - from urgent to high-tech. The policy is in the form of A5 paper in the old and new versions or a plastic card - all options are equal.

The document can be received by:

• Citizens of the Russian Federation, including the smallest. The policy is issued from birth to everyone, except for military personnel and those equated to them - they have their own system of assistance.
• Foreigners permanently or temporarily residing in Russia, except for those who are sent to work in branches, representative offices and subsidiaries of companies registered in the member countries of the World Trade Organization.
• Stateless persons.
• Refugees who are eligible for medical assistance.

If you do not have such a policy, you need to get one. To do this, with an identity card and SNILS, contact any insurance organization that you can find on the website of the territorial CHI fund. Non-citizens will need additional documents such as a residence permit or refugee certificate.

You can apply for a policy in person or through a multifunctional center. True, the latter is not available everywhere, so it is better to check in advance. The procedure for issuing a new policy, if you have lost it, spoiled or changed your personal data, is the same.

2. The OMS policy is valid throughout Russia

For traveling abroad, insurance is usually taken out. You never know what can happen to health. And with a policy, you won't have to pay terrible sums for treatment.

Travel insurance in Russia is already built into the compulsory medical insurance policy. If necessary, you can go to the local hospital, emergency room or call an ambulance with it. And help should be provided free of charge under the compulsory health insurance program. So it's better to carry the document with you.

At the same time, the authorities promise that from 2022 all information about policies will be stored in a single information system. The corresponding decree has already been signed by Prime Minister Mikhail Mishustin. And you will not need to carry a policy on paper with you, it is enough to present your passport. So as planned, although practice sometimes diverges from it.

With the policy, you can also attach to any clinic if you have moved to another region. True, in this case, you may have to change the insurance, if the institution is not operated by the same company as yours.

3. The compulsory medical insurance policy gives the right to free medicines

As part of inpatient treatment or emergency medical care. Under the compulsory medical insurance policy, these services are free for the patient, which applies to drugs and consumables: bandages, syringes, and so on. But only if they are included in the list of essential medicines. It is approved by the government annually. Sometimes deviations from the list are possible, but there must be important reasons for this, such as individual intolerance to the drug.

If the hospital requires a patient to buy something, he can complain to the insurer, to the local health department, or to the prosecutor's office.

True, the medal has a downside. The state has mastered the whip method. But there is not always enough money for a full-fledged purchase of medicines. So doctors are put in a strange situation: patients cannot be asked for anything, it is fraught with punishment. But it is also necessary to treat them somehow, and not always have something. Cardiologist Artemy Okhotin in the episode of the podcast "It happened so" said that sometimes doctors even buy drugs at their own expense.

By the way, you can get a lot of medical services under the policy.

4. The compulsory medical insurance policy also works in commercial clinics

But they must be accredited in the CHI system. Compulsory health insurance works just like any other. A person goes to a doctor, that is, an insured event occurs. The doctor provides the patient with a list of services, each of which is estimated at a certain amount. After that, the data goes to the insurance company, and she subsequently transfers the money to the medical institution.

The insurance company, in fact, does not care who to pay. If a private clinic is satisfied with the compulsory medical insurance rates, it can join the program and provide services under policies. In this case, the client does not pay for anything, the insurance company pays for everything. But only within the framework of the services provided for by the compulsory medical insurance. The rest is paid.

Look for the list of medical institutions working in the CHI system on the website of the territorial compulsory health insurance fund.

5. IVF can be done under the compulsory medical insurance policy

In vitro fertilization is carried out free of charge for patients with a policy, if there are indications for the procedure. Applicants are selected by a special commission based on the results of research, which is also done within the framework of the CHI.

The indication for IVF is a situation when other methods of infertility treatment do not help within 12 months, and for women over 35 years old - within six months.

6. Emergency assistance should be provided even without a policy

In case of emergency conditions and exacerbation of chronic diseases that pose a threat to the patient's life, medical care should be provided quickly and without regard to the policy. The medical institution will still be paid, just not from the insurance finance. Money for this is allocated from the budgets of different levels of government.

7. The compulsory medical insurance policy gives medical institutions the possibility of fraud

This is especially true for polyclinics, because it is easiest for them to do something like that. As we figured out above, money is transferred to organizations for services rendered. Therefore, sometimes, in order to get more funds, patients are credited with non-existent visits and even illnesses. In the future, this can blur the medical picture and prevent you from getting qualified help. Therefore, it is worth checking periodically to see if you have been healed without your knowledge.