How to use health insurance policy. Registration of an electronic compulsory medical insurance policy. Do foreign citizens need a compulsory medical insurance policy?

Almost every Russian has a compulsory health insurance policy, but not everyone has a clear idea of ​​where and what kind of medical care can be obtained using it. About what rights we are entitled to under the compulsory medical insurance policy and how to use it correctly, including in a foreign city, and when the policy may be useless, in an educational lesson from Tatyana Serebryakova, an expert at the Interregional Union of Medical Insurers.

What treatment does the compulsory medical insurance policy not entitle you to and should you not insist on it?

The patient cannot qualify for treatment under the compulsory medical insurance policy in the two most common situations.

Firstly, when applying to a medical institution that is not funded by compulsory medical insurance for a certain profile. Each medical organization, both private and public, applies once a year to participate in the compulsory medical insurance system. Moreover, not “in general,” but according to specific profiles and types of treatment. And it is not a fact that the hospital or clinic you choose provides exactly the services that you need under the compulsory medical insurance policy. That is, when contacting a medical institution, you need to find out two main parameters: whether it participates in the compulsory medical insurance system, and under what types and conditions (all or some specific ones) in terms of profiles, medical specialists, assistance to children or adults.

Secondly, if the treatment itself is not among those financed by compulsory medical insurance. This applies, for example, to sexually transmitted diseases, HIV, AIDS, tuberculosis, mental and behavioral disorders, palliative care (both inpatient and outpatient). Such medical care is financed from other sources of the State Guarantee Program - funds from the federal, regional or local budget. The compulsory medical insurance policy does not cover treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there are no medical indications for this), preferential dental prosthetics, sanatorium treatment, as well as the provision of medical care in conditions exceeding the level of comfort established by the program.

In addition, the number of services that are not financed by compulsory medical insurance, and therefore are not provided under the policy, does not include social benefits. For example, related to preferential drug coverage for outpatient treatment. That is, if in a hospital all medications are provided free of charge, then a patient who does not have the right to benefits pays for a prescription received at an appointment in a clinic independently. Sick leave payments are also not related to the compulsory medical insurance policy - this is a type of social benefit that is paid from social insurance funds.

Does it matter if a person gets sick while in a place where he does not have permanent registration?

You can get treatment for free anywhere in the country, the main thing is not to forget to take a compulsory health insurance policy when traveling. But this applies to medical care under the basic compulsory medical insurance program, which is approved by the Decree of the Government of the Russian Federation and is absolutely the same in all regions of Russia. That is, any acute condition or exacerbation of a chronic disease, toothache, bruises, poisoning, allergies or sunstroke - all these are reasons to seek free help from a clinic or hospital operating in the compulsory medical insurance system.

If your condition worsens, you also have the right to free ambulance and emergency outpatient care. Moreover, when providing emergency medical care in cases that threaten a person’s life, presentation of a compulsory medical insurance policy is not required. Such assistance is provided to everyone, without exception, free of charge and without delay.

However, in other cases there is a difference between the permanent place of residence and the region of temporary residence. This difference applies to those medical services that are provided in addition to the basic compulsory medical insurance program. For example, in a number of regions of the Russian Federation with a high level of socio-economic development, the Territorial Compulsory Medical Insurance program is much broader - due to certain types of high-tech medical care that are not included in the basic program. In addition, due to the “super-basic compulsory medical insurance program” the scope of preventive measures can be expanded. But the extended program is available only for residents of this specific region. A nonresident patient will not be provided with services beyond the basic compulsory medical insurance program free of charge under the compulsory medical insurance policy.

What if the disease is associated with some local characteristics? For example, a Muscovite traveling in Transbaikalia was bitten by a tick.

You are required to provide medical care under the compulsory medical insurance policy (including removing a tick) at any emergency room. If a bite-related disease develops, it should also be treated free of charge - at the expense of compulsory medical insurance funds. This also applies to other similar situations, regardless of where the sick person is located.

Is it possible to get sick leave if you get sick while traveling?

A person has the right to receive sick leave in any region of the country. It all depends on medical indications that indicate that he is incapacitated. If you cannot go to the clinic, call a doctor at home. Medical care at home must also be provided under the compulsory medical insurance policy.

If the situation is not an emergency, and a person on vacation simply has time to take care of his chronic illness, will he be provided with planned assistance?

The Compulsory Medical Insurance policy allows you to seek routine medical care anywhere in the country. The disease profiles for which such assistance is provided are listed in the basic compulsory medical insurance program. However, planned treatment, for example, adjusting the dose of insulin or selecting a hypertensive drug, is a rather lengthy process that requires a lot of examinations, additional consultations, etc. Therefore, it is better to do this at home, in consultation with your doctor. If you are planning to leave for another region for a long time and know that at this time you may need routine medical care, attach yourself to the clinic at your place of stay.

Or maybe in another region they will declare that the compulsory medical insurance policy is invalid?

The current policy guarantees the provision of free medical care under the basic compulsory medical insurance program throughout Russia. Enter your insurance company's hotline number in your mobile phone address book and call it in any case of dispute. If you have not used your policy for a long time, call your insurance company’s hotline (the telephone number is indicated on the policy) and find out if there is data about it in the relevant register of insured persons. The best thing is to replace it with a new compulsory medical insurance policy of a single standard. To do this, it is enough to contact any insurance company, but it is better to schedule a visit 1.5 months before the intended trip.

What to do if a patient is forced to pay for treatment?

Contact the head of the medical organization, call the Territorial Compulsory Medical Insurance Fund of the region in which you are not in the place of insurance, and where you were denied medical care or required to pay for it. Today, in every subject of the Russian Federation, the work of Contact Centers in the field of compulsory medical insurance has been organized; the telephone number of such a Contact Center should be posted on stands in every medical institution, on the website of each Territorial Compulsory Medical Insurance Fund. This number and other details of the Contact Center will always prompt you if you call the hotline of your insurance company.

If you had to pay, keep the receipt and warn that you will appeal this forced payment (write a complaint). If you are offered to sign an agreement for the provision of paid services (otherwise, paying for medical care in the Russian Federation is not legal) - read it carefully and do not sign if it states that you are aware that you can receive medical care for free, but have voluntarily decided pay.

Almost every Russian has a compulsory health insurance policy, but not everyone has a clear idea of ​​where and what kind of medical care can be obtained using it. About what rights we are entitled to under the compulsory medical insurance policy and how to use it correctly, including in a foreign city, and when the policy may be useless, in an educational lesson from Tatyana Serebryakova, an expert at the Interregional Union of Medical Insurers.

What treatment does the compulsory medical insurance policy not entitle you to and you shouldn’t insist on it??

The patient cannot qualify for treatment under the compulsory medical insurance policy in the two most common situations.

Firstly, when applying to a medical institution that is not funded by compulsory medical insurance for a specific profile. Each medical organization, both private and public, applies once a year to participate in the compulsory medical insurance system. Moreover, not “in general,” but according to specific profiles and types of treatment. And it is not a fact that the hospital or clinic you choose provides exactly the services that you need under the compulsory medical insurance policy. That is, when contacting a medical institution, you need to find out two main parameters: whether it participates in the compulsory medical insurance system, and under what types and conditions (all or some specific ones) in terms of profiles, medical specialists, assistance to children or adults.

Secondly, if the treatment itself is not among those financed by compulsory medical insurance. This applies, for example, to sexually transmitted diseases, HIV, AIDS, tuberculosis, mental and behavioral disorders, palliative care (both inpatient and outpatient). Such medical care is financed from other sources of the State Guarantee Program - funds from the federal, regional or local budget. The compulsory medical insurance policy does not cover treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there are no medical indications for this), preferential dental prosthetics, sanatorium treatment, as well as the provision of medical care in conditions exceeding the level of comfort established by the program.

In addition, the number of services that are not financed by compulsory medical insurance, and therefore are not provided under the policy, does not include social benefits. For example, related to preferential drug coverage for outpatient treatment. That is, if in a hospital all medications are provided free of charge, then a patient who does not have the right to benefits pays for a prescription received at an appointment in a clinic independently. Sick leave payments are also not related to the compulsory medical insurance policy - this is a type of social benefit that is paid from social insurance funds.

Does it matter if a person gets sick while in a place where he does not have permanent registration?

You can get treatment for free anywhere in the country, the main thing is not to forget to take a compulsory health insurance policy when traveling. But this applies to medical care under the basic compulsory medical insurance program, which is approved by the Decree of the Government of the Russian Federation and is absolutely the same in all regions of Russia. That is, any acute condition or exacerbation of a chronic disease, toothache, bruises, poisoning, allergies or sunstroke - all these are reasons to seek free help from a clinic or hospital operating in the compulsory medical insurance system.

If your condition worsens, you also have the right to free ambulance and emergency outpatient care. Moreover, when providing emergency medical care in cases that threaten a person’s life, presentation of a compulsory medical insurance policy is not required. Such assistance is provided to everyone, without exception, free of charge and without delay.

However, in other cases there is a difference between permanent residence and temporary residence region. This difference applies to those medical services that are provided in addition to the basic compulsory medical insurance program. For example, in a number of regions of the Russian Federation with a high level of socio-economic development, the Territorial Compulsory Medical Insurance program is much broader - due to certain types of high-tech medical care that are not included in the basic program. In addition, due to the “super-basic compulsory medical insurance program” the scope of preventive measures can be expanded. But the extended program is available only for residents of this specific region. A nonresident patient will not be provided with services beyond the basic compulsory medical insurance program free of charge under the compulsory medical insurance policy.

What if the disease is associated with some local characteristics? For example, a Muscovite traveling in Transbaikalia was bitten by a tick.

You are required to provide medical care under the compulsory medical insurance policy (including removing a tick) at any emergency room. If a bite-related disease develops, it should also be treated free of charge - at the expense of compulsory medical insurance funds. This also applies to other similar situations, regardless of where the sick person is located.

Is it possible to get sick leave if you get sick while traveling?

A person has the right to receive sick leave in any region of the country. It all depends on medical indications that indicate that he is incapacitated. If you cannot go to the clinic, call a doctor at home. Medical care at home must also be provided under the compulsory medical insurance policy.

If the situation is not an emergency, and a person on vacation simply has time to take care of his chronic illness, will he be provided with planned assistance?

The Compulsory Medical Insurance policy allows you to seek routine medical care anywhere in the country. The disease profiles for which such assistance is provided are listed in the basic compulsory medical insurance program. However, planned treatment, for example, adjusting the dose of insulin or selecting a hypertensive drug, is a rather lengthy process that requires a lot of examinations, additional consultations, etc. Therefore, it is better to do this at home, in consultation with your doctor. If you are planning to leave for another region for a long time and know that at this time you may need routine medical care, attach yourself to the clinic at your place of stay.

Or maybe in another region they will declare that the compulsory medical insurance policy is invalid?

The current policy guarantees the provision of free medical care under the basic compulsory medical insurance program throughout Russia. Enter your insurance company's hotline number in your mobile phone address book and call it in any case of dispute. If you have not used your policy for a long time, call your insurance company’s hotline (the telephone number is indicated on the policy) and find out if there is data about it in the relevant register of insured persons. The best thing is to replace it with a new compulsory medical insurance policy of a single standard. To do this, it is enough to contact any insurance company, but it is better to schedule a visit 1.5 months before the intended trip.

What to do if a patient is forced to pay for treatment?

Contact the head of the medical organization, call the Territorial Compulsory Medical Insurance Fund of the region in which you are not in the place of insurance, and where you were denied medical care or required to pay for it. Today, in every subject of the Russian Federation, the work of Contact Centers in the field of compulsory medical insurance has been organized; the telephone number of such a Contact Center should be posted on stands in every medical institution, on the website of each Territorial Compulsory Medical Insurance Fund. This number and other details of the Contact Center will always prompt you if you call the hotline of your insurance company.

If you had to pay, keep the receipt and warn that you will appeal this forced payment (write a complaint). If you are offered to sign an agreement for the provision of paid services (otherwise, paying for medical care in the Russian Federation is not legal) - read it carefully and do not sign if it states that you are aware that you can receive medical care for free, but have voluntarily decided pay.

A plastic compulsory medical insurance policy is an official document giving the right to receive free medical care throughout the Russian Federation. Compulsory health insurance is the basis of the reform of the health care system, which involves increasing the level of service to citizens in clinics and hospitals and strengthening the health of Russians in general.

Electronic compulsory medical insurance policy

A plastic policy is one of the types of documents valid on the territory of the Russian Federation. Gives the right to free medical care on a par with paper media and a universal electronic card.

Health insurance services are provided by commercial companies that have received appropriate authority from the state. The essence of the service is to fully cover the costs incurred in the event of an insured event that meets the terms of the signed contract.

Compulsory Medical Insurance Policy electronic Card

In appearance, the compulsory medical insurance policy resembles a standard bank policy. The dimensions of the document are exactly the same. The front side is designed as a three-color background, where a chip is placed, a unique document number and the name of the insurance organization are printed. On the back of the card is a photograph of the owner, his full name, as well as the validity period of the document.

Children's electronic policies are issued without photographs. Modern plastic documents have no expiration dates.

Electronic compulsory medical insurance policy where to get

Plastic medical policies are issued in branches of insurance companies that have received permission from the state to conduct relevant activities. Paper documents are issued by all insurance companies throughout the country, while plastic documents are issued on special equipment, which is not available in all cities of our country. It is recommended to find out the addresses and telephone numbers of insurance companies that cooperate with clinics or hospitals closest to you at the place where you receive medical services.

How to get an electronic compulsory medical insurance policy

To receive an electronic or paper policy, you must present the following documents to the insurance company:

1. A completed and signed application.
2. Birth certificate and passport (if the child is already 14 years old).
3. Parents' passports, if the policy is obtained for a minor child.
4. SNILS, if available.

Foreign citizens present the following documents:

1. Passport of your state.
2. A residence permit or passport with a note indicating the right to stay in Russia.
3. SNILS, if available.

Electronic compulsory health insurance policy

After submitting the application, a temporary document is issued, which is valid for 30 days. Along with the compulsory medical insurance policy, the insured person is given a visual reminder, which tells how to use the document and what medical services are provided free of charge. Relatively recently, employers were involved in issuing insurance policies. Today this responsibility has fallen on the shoulders of the ordinary citizen. And the “place of work” field, typical for older versions of the document, was completely excluded.

How to use an electronic policy

The compulsory medical insurance policy is valid in all regions of the Russian Federation, so it is recommended to always take the document with you like a passport and driver’s license. Thus, the insured person has the opportunity to receive high-quality and completely free medical care in any subject of the Russian Federation. Of course, in emergency situations, emergency assistance is provided even in the absence of a document. Be sure to remember, or better yet, write down the insurance policy number, which will definitely come in handy when visiting a medical facility without a document, as well as in case of damage or loss.

Advice from Sravni.ru: If you have a medical policy, any refusal to provide services is unlawful. In such situations, it is recommended to immediately notify the insurance company, law enforcement agencies and contact the management of the clinic or hospital. The capabilities of a plastic compulsory medical insurance policy are comparable to those of a paper document, the receipt of which is allowed only in some branches of the compulsory medical insurance and not in all cities. A paper document is issued everywhere, but regardless of the material from which the policy is made, the insured person receives the same rights to free medical care.

Electronic insurance is a step forward in the world of technology. Humanity does not stand still. Electronic insurance resembles a plastic card. It is small and convenient. And most importantly, always at hand. The plastic card contains information that concerns the owner of the policy. The card contains the surname, first name and patronymic of the owner. His place of birth, date of birth. And, of course, an individual number.

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You can get it from your health insurance company. Most Russian cities do not issue it. At the medical institution you can find out the number where you can get information about issuing a plastic card.

To obtain a card, the following documents are required:

1. Identity passport.
2. A statement that the citizen wants to issue a plastic card.
3. If done for a minor child, then you need a passport or birth certificate.
4. Under 18 years of age, a parent's passport is required.

Exchange the policy for a new one. In what case is this done:

1. Changes in last name, first name, patronymic.
2. If you suddenly find an error.
3. If the old one was lost or torn.

Do you need an electronic compulsory medical insurance policy?

An insurance policy, or rather an electronic card, is very convenient. It does not take up much space and can fit into the simplest wallet. At any moment, when you go to a medical facility, the card will always be nearby.

But, in fact, you can get by with paper. Electronic version, more designed for convenience. According to their data, they are similar. Both in paper and card versions. The details of the owner of the document are indicated.

Advantages and Disadvantages

A plastic policy in the form of a card is an innovation. But there are still reasons to wonder whether it is necessary. Like every new product, there are disadvantages and advantages.

Disadvantages of such a policy:

1. Not every branch can get it.
2. When moving to another place of residence. You will have to give away your plastic card. And in return they will issue the same old paper policy. The chip carries certain information. And this information, unfortunately, cannot be changed.

Advantages:

1. Convenient, small, compact.
2. Doesn't tear.
3. Always with you.

Unfortunately, this type of card policy has many more disadvantages. Therefore, each person must decide for himself. Whether he is needed or not.

Step-by-step instructions for receiving

A plastic card can be obtained by:

1. Citizens of the Russian Federation.
2. Citizens who have lived here for a long time. This applies to foreign citizens.
3. Stateless persons.

To get a plastic version, i.e. a card. You must contact one of the CHI branches. But not every branch can issue this card. Therefore, it is best to find out the phone number from a medical institution. Call and find out exactly where you can apply for it.

To apply for compulsory health insurance electronically:

1. Write a statement. In which to indicate that the citizen wishes to take out a plastic version of compulsory health insurance.
2. A passport that proves your identity.
3. Passport if the application is for a child under 14 years of age.
4. Parents' passport if the child is under 18 years old.
5. If available, you can provide SNILS.
6. Other documents that may be required when registering an electronic policy.

How to use the new electronic policy

What is an electronic card with a chip:

1. It contains individual data.
2. Personal photo of the owner.

With the help of these facts, no stranger will be able to use this document.

If citizens often, then it is necessary in this case to always take an insurance document with you. This gives the right to medical care. If there is no insurance policy, then the only thing a person has the right to is first aid. If a person often forgets to take his compulsory medical insurance document with him. In this case, it is best to try to remember your individual number. This may be useful in the future.

Every person should know that a medical institution does not have the right to refuse assistance to a sick or injured person, with or without a policy. With the presence of an electronic card, the range of services increases.

Several years ago, compulsory health insurance policies of a new type began to be issued in the Russian Federation. Now, instead of paper, you can get a mobile and convenient plastic card. You will find out what an electronic compulsory medical insurance policy looks like and what it is further.

Appearance of the new compulsory medical insurance policy

The electronic compulsory medical insurance policy (EPOMS) has the form of a plastic card. It is the same size as a bank card. It is compact and easily fits in a wallet along with other cards and business cards.

On the front side of the card you can see:

• in the upper part - the coat of arms of the Russian Federation, the name of the document “Compulsory Health Insurance Policy”, the logo of the compulsory medical insurance system;
• in the middle - a microchip for reading data from the electronic compulsory medical insurance policy about the insured person, the insurer, and the features of the insurance program;
• Below is an individual 16-digit insurance code.

To the right of the chip is an imprint of the insurance organization with its name, the name of the branch, and its contact information.

Example:

The reverse side of the document looks like this:

• in the upper part - contact telephone number of the Territorial Compulsory Medical Insurance Fund (TFIF), signature of the insured, blue POMI badge
• in the middle there is a holographic sign confirming the authenticity of the document;
• below – full name and photograph of the owner, serial number (under it), validity period of the document, gender of the insured person, date of birth.

Example:

Advantages and disadvantages of EPOMS

Each innovation has its pros and cons. An electronic compulsory health insurance policy began to be issued in order to improve the health insurance system. Its owners are faced with the advantages and disadvantages of this document.

Advantages:

1. Convenience and compactness. Thanks to its small size, EPOMS easily fits into a wallet. This is how a paper policy differs from a plastic one.
2. Strength and wear resistance. The plastic does not tear, and the data on it is not erased - the information can always be easily read.
3. Replacing a paper compulsory medical insurance with an electronic one is absolutely free.
4. Only the insured can use the compulsory medical insurance policy in public hospitals and clinics. The card is protected from fraudsters by a PIN code, a chip, and a photo of the owner.
5. Thanks to EPOMS, the insured person can make an appointment with a doctor through his personal account on the Internet portal of public services or through a terminal.

Flaws:

1. Not all clinics are equipped with the necessary equipment and software to work with scanners or chip readers.
2. Not all insurers issue EPOMS.
3. When changing personal data, you cannot simply rewrite it onto the chip - you will have to change the card itself.

Where can I get a plastic health insurance card?

Health insurance holders often put off replacing paper media with EPOMS until later, as they fear that this procedure may take a long time. In fact, getting a plastic policy is not problematic. How to get EPOMS?

You can request a replacement:

• to your insurer. You can find out which company has your insurance at your medical facility. Usually this is a local clinic. You can get acquainted with the list of points where insurance is replaced on the website of your insurance organization or regional TFOMS;
• in any insurance organization. If you want to change your insurer, you can view the list of insurance companies on the website of the regional TFOMS, and you can also check the EPOMS there;
• on the government services website. To do this, you need to register on this resource, go to the section “What is a compulsory medical insurance policy and how to get it” and fill out an application. However, this option is currently being finalized, so issuing an electronic compulsory health insurance policy through government services is temporarily not possible. You can order EPOMS online only in some regions of the country, for example, in Moscow or St. Petersburg;
• through MFC. You can get a card at any branch of the MFC by handing over a package of necessary papers to the operator and filling out an application;
• to the employer. Officially employed citizens can notify the human resources department at their enterprise of their desire to receive an electronic policy. Large organizations themselves send the paperwork to the insurer, but you will have to receive the EPOMS in person.

The list of insurers that provide medical insurance includes large and reliable organizations, such as SOGAZ-Med, RESO-Med, Rosgosstrakh-Medicine, Ingosstrakh-M.

Step-by-step instructions for receiving

To replace an old-style contract with a new plastic card, you must follow the following instructions:

1. Find out the contacts of your insurer or choose a new organization and call the main office in advance to find out which branches are issuing plastic cards;
2. Come to the insurer's office;
3. Write an application, provide documents for consideration and receive a temporary certificate of insurance;
4. Come get new insurance. Usually its production takes no more than 10 days. By law, the card must be issued no later than 30 days after submitting the application.

A PIN code and a pack code are issued along with the card. Why are they needed? A PIN code is required to confirm that the information is entered with the user’s knowledge, and a PACK code is needed to unlock the card in the event of an incorrect PIN code entered three times. Activation of EPOMS occurs upon first use.

Required documents

To obtain an EPOMS, you need to collect the following papers:

• civil passport or birth certificate of the insured person;
• application for replacement;
• individual personal account insurance number (SNILS);
• old insurance contract (optional).

If the card is issued for a minor, he must be accompanied by a parent with his passport or a legal representative with a passport and a power of attorney, which is dictated by the Rules of Compulsory Health Insurance. For children under 14 years old, having a SNILS is not a requirement.

Do I need to change the old contract to a new one?

It is advisable to replace health insurance contracts received before 2011 with new documents, but this is not a mandatory condition. Insurance is considered valid until its term has expired - this is stated in Art. 51 clause 2 of the Federal Law “On Compulsory Health Insurance in the Russian Federation”. Consequently, health workers do not have the right to refuse to provide medical care upon seeing an old-style document, since it is valid.

Sooner or later, the document will need to be replaced, because previously health insurance was issued with an expiration date. Thus, it is advisable to make a replacement as early as possible, because using the electronic compulsory medical insurance policy, you can make an appointment with a doctor remotely, and besides, it is unlimited.

Conclusion

An electronic health insurance card is an extremely convenient and useful thing. Thanks to it, you can forget about queues at clinics by making an appointment online. In February 2017, the issuance of plastic cards was suspended, but on May 1 of the same year it was resumed - now every citizen can replace their old paper health insurance contract with a compact electronic compulsory medical insurance policy with a Russian-made micron chip.

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