The Moscow City Fund for Compulsory Medical Insurance was established by the Moscow government and the Moscow City Duma in 1993 to provide constitutional guarantees to residents of the metropolis to provide free medical care. The guarantor is the compulsory medical insurance policy.
Moscow City Fund of Compulsory Medical Insurance: Goals and Objectives
Objectives of the project:
- maximum efficiency in the use of the fund's financial resources;
- improving the quality of medical care offered to the population under the compulsory medical insurance program.
To solve the set tasks, the foundation developed and approved special programs aimed at receiving, processing, protecting, storing and transmitting information in the database.
Tasks of the Moscow City Fund of Compulsory Medical Insurance
The responsibilities of MGFOMS representatives working in the administrative districts of Moscow include:
- control of issue;
- identification of violations related to the procedure for the provision of medical care in district polyclinics;
- monitoring the strict performance of functions by medical insurance organizations.
There are hospitals, clinics, insurance companies, and regional funds. The subjects include regional funds, insurers and citizens who have received a policy.
Territorial attachment to a polyclinic in Moscow according to MGFOMS
Muscovites have the legal right to independently choose any medical organization participating in the CHI program from the existing list. Before applying for attachment to an institution providing primary medical assistance, the insured must:
- familiarize yourself with the list of doctors who are receiving appointments;
- find out the number of persons attached;
- get information about the doctor's sites.
To be attached, a citizen, or his representative, must come to the clinic and write an application according to the proposed model. After checking the data specified in the application, the polyclinic will notify the citizen about the attachment. Attached persons can make an appointment with a doctor electronically.
If you want to change the clinic, you do not need to detach from the previous organization. The selected institution will do this on its own.
Change of insurance company for medical insurance
After entry into force Federal law on compulsory health insurance, insured citizens have the right to independently choose a medical institution for attachment. This is due to the transition of medical organizations operating in, to the per capita method of financing for outpatient and polyclinic services for the attached population.
People who are dissatisfied with the services of the company in which they are insured have the right to choose another organization from the list offered on the official website of MGFOMS.
Citizens can change the organization:
- come of age, or capable in full;
- legal representatives of the child(parents and people with a power of attorney) under a certain age.
Replacement can only be made once a year until November 1. An exception is moving to another place of residence, or termination of the contract.
Obtaining a policy
Thanks, citizens receive the necessary medical assistance free of charge. Electronic policies, which appeared in August 2015, replaced previously issued green plastic cards and blue forms with information printed on them.
Every citizen has the right to replace the old document with a new one electronic policy by contacting your medical organization with a statement.
OMS policy in Moscow
is a document that no one except the owner can use, which is due to the presence of a chip, personal signature and a photo of the insured. The document number is displayed on the front side. The reverse side contains full information about the owner of the policy with his signature, as well as the validity period of the document.
To make an appointment with a specialist, a citizen with an electronic policy can use both a public service portal and an electronic terminal. Old-style documents are considered valid until replaced with electronic ones. A person who wants to receive an electronic policy must write an application using a special form, collect a package required documents and contact insurance company, in which he received the old policy.
Any form, issued to citizens free of charge and valid throughout the territory of the Russian Federation.
The set of documents attached to the application depends on the age and citizenship of the person applying for the policy. WITH complete list the documents required when submitting an application can be found on the official website of MGFOMS in a special section.
Policy check
Muscovites can use online service, on the MGFOMS website. To do this, you need to know the document number. Usually, the need for verification arises when a citizen's employment status changes, or his uncertainty about the existence of the organization that issued the policy.
Information about the document that appeared on the screen after entering the data informs that the policy is valid. In the event that information could not be obtained, the insured person should contact insurance organization for registration of a new document.
The authenticity of the document can be established using the telephone. Having provided the number of the policy to the official representative, the citizen will receive the necessary information.
A check by last name can be carried out by people who have forgotten the document number. To do this, you need to go to the MGFOMS website and fill out an online form by entering your full name and passport data, or your full name, date of birth and address of residence. After that, the number of the current policy is displayed on the screen.
The procedure for protecting the rights of insured citizens
Protection of the rights of citizens insured in is fully entrusted by the Moscow government to insurance companies. The rights of insured citizens can be defended in court or during pre-trial proceedings. Insured citizens independently choose the way to protect their rights.
To do this, you must draw up a complaint and send it to the following authorities:
- the head of a medical institution;
- the management of health care operating in the territory of the corresponding administrative district;
- city health department;
- the organization that issued the policy;
- GAEK;
The city arbitration expert commission accepts applications that were considered by the insurance organization without a positive result.
Complaint about compulsory medical insurance
Protection of the rights of the insured is carried out in several stages:
- acceptance and consideration of the complaint;
- examination of the quality of medical care provided;
- launching a mechanism for pre-trial resolution of the conflict;
- analysis of the obtained expert data;
- decision-making.
MGFOMS has launched an electronic service that will inform insured citizens in detail about medical care provided at the expense of CHI funds.
Using the website of the Moscow City Compulsory Medical Insurance Fund, you can get data on the cost, location and result of the examination. The main task of the service is to help the insured person correctly assess the availability and quality of medical care received.
Key performance indicators
The main activity of the fund is to ensure the protection of the rights of the insured in Muscovites, the quality improvement method health care and its availability to all categories of the population.
The rights of insured citizens are protected in several ways:
- consideration of appeals and complaints of Muscovites, study of information, analysis and decision-making;
- control over the activities of the HIO in connection with the complaints received;
- conducting expert events.
The basis for making certain decisions is the results of the fund's expert activities. The Foundation or CMO are the organizers of the EKMP. The examination is carried out by doctors included in the roster of experts. On the this moment in the territorial reference book there are 480 doctors, and more than 45 specializations. At the same time, MGFOMS provides multilevel quality control of examinations, which excludes the occurrence of errors and incorrect conclusions.
Most often, the check reveals violations associated with the financial and economic activities of medical institutions: inconsistency of documentary data with the state of accounts, or mismatch of paid bills with the register.
Also, as a result of the examination, the following are revealed:
- violations admitted in the provision of medical care;
- poor patient care upon occurrence of an insured event.
The Foundation considers and satisfies all appeals and complaints of citizens.
Benefits of an electronic service for insured citizens
Every citizen can receive any information of interest through a personal account created on electronic service MGFOMS. With the help of the data obtained, Muscovites can monitor the activities of the fund, find out the conditions for the provision of free medical care, compare the work of a particular medical institution and real value services rendered.
The insured citizen can enter his contact information, indicate the presence of chronic and past diseases, allergic reactions and other information that will be available to emergency doctors online. In the event of an emergency call, they will receive the necessary data on the way to the patient, and choose the most effective tactics for providing assistance.
Insured persons with the help of the service can independently, attach to the clinic and information about the provided medical services.
Services under the compulsory medical insurance policy in the Moscow State Fund, video
Citizens insured in the CHI system and using the capabilities of the "Personal Account" can, on the basis of the information received, objectively assess the activities of medical organizations, the quality and availability of services, and also monitor the fund's expenses. See also information about dental treatment under the compulsory medical insurance policy for free.
Contacts
Moscow City Fund of Compulsory Medical Insurance
Foundation website (with the possibility of contacting through the registration form):
http://www.mgfoms.ru/
Addresses and telephones:
Moscow City CHI Fund
Address: 117152, Moscow, Zagorodnoe highway, 18a
Department for the provision of the rights of the insured: 952-93-21
City Arbitration Expert Commission (GAEC)
Contact phone: 952-93-21
Federal Compulsory Medical Insurance Fund
Address: 127994, Moscow, Novoslobodskaya st., 37
Phone: 8.499-49 3-44-55, fax: 8.499-49 3-49-30
Moscow Regional Compulsory Medical Insurance Fund
Address: 1 15114, Moscow, Derebenevskaya emb. , 7, building 1
Phone: 2 23 - 71 - 36, ext. 11-73 (Department for the protection of the rights of the insured)
Moscow City Health Department
On duty - phone: 251-83-00 (around the clock)
Address: 1 27 006, Moscow, Oruzheiny per., 43
Hot line Department of Health of the city of Moscow -
phone: 251-14-55,
opening hours: Mon. - Fri. from 9:00 to 20:00, Sat. - Sun. - weekend
Hotline of the Pharmacy Directorate of the Healthcare Department of the city of Moscow - phone: 623-46-36 (on weekdays)
Information on the availability of medicines and medical products in the city of Moscow - phone: 927-05-61,
opening hours: Mon. - Fri. 9:00 am 0 - 8:00 pm, Saturday 9:00 am - 6:00 pm, Sunday 10:00 am - 4:00 pm
The addresses and telephones of the health departments of the administrative districts of Moscow are on the foundation's website.
Some questions and answers on compulsory medical insurance in Moscow
Question:
I have heard and read many times that the compulsory medical insurance policy gives the right to receive free medical care included in the Moscow city compulsory medical insurance program. But how do you know if this or that medical service is included in this program?
Answer:
You should contact your insurer OMS insurance medical organization. Her address and telephone number of the inquiry service are on your compulsory medical insurance policy.
Question:
I heard that in medical institutions providing free medical services can be provided and paid. Is it so? Could you tell us what these services are and what is the procedure for obtaining them?
Answer:
Yes, this is correct. Along with free medical services in the same medical institution in Moscow, services for a fee can also be provided. They can be provided only in those state and municipal medical institutions in Moscow that have licenses for the relevant types of medical activities and permission from the Moscow City Health Department to provide paid medical services. In this case, citizens must be provided with the following information:
* about the location of the institution (the place of its state registration);
* on the operating hours of the institution, departments and offices for the provision of paid and free medical care;
* about the types of paid medical services with an indication of their prices;
* on the rights, duties, responsibilities of the patient and the medical institution;
* on the presence of a license for medical activities;
* about the benefits provided by a medical institution for selected categories citizens;
* about controlling organizations, their addresses, telephones.
For a fee, the following can be rendered primarily:
* medical and service services with an increased level of comfort;
* hospitalization in specially allocated beds (in excess of the state order);
* treatment and examination for concomitant disease in the absence of exacerbation, which does not affect the severity of the underlying disease;
* examination, treatment, supervision at home (except for cases when the patient for health reasons and the nature of the disease is not able to visit a medical institution or when home assistance is provided within the framework of the organization of hospitals at home);
* home care;
* anonymous medical services (except for cases stipulated by the legislation of the Russian Federation);
* medical services using permitted alternative technologies and methods of treatment, the costs of providing which are not included in the standard cost of treatment at the expense of the corresponding budgets or funds of the compulsory medical insurance.
At the same time, for a fee, individual medical services related to preventive, therapeutic and diagnostic, rehabilitation, prosthetic and orthopedic, dental care can also be provided. Therefore, the medical institution must first inform the patient about the possibility of receiving the service free of charge and, in addition to the contract, obtain the patient's written consent to the paid medical service. It must contain information that he is aware of the available alternative to receiving health care services free of charge and agrees to receive these services for a fee.
The patient must first conclude an appropriate contract with the medical institution. It can be concluded both orally and in writing. The oral form of the contract is provided in cases of immediate provision of the service. Written proof of its provision is the patient's medical record with a list of services provided, cashier's check or a form of strict reporting on payment for services, the amount of which corresponds to the price list of services. The written form is provided in cases of providing a long-term nature of the service (services). At the same time, the contract must regulate the terms and conditions for obtaining the service, the procedure for calculating, the rights, obligations and responsibilities of the parties.
It happens that the patient, having given consent to receive paid service, after a while he finds out that it could have been provided to him free of charge, and asks to return the money spent from the OMS funds to him.
Therefore, in order not to become a hostage of such a situation, first find out the procedure and conditions for the provision of paid medical services in this institution, the possibility of receiving them free of charge.
You can also contact an insurance medical organization for clarifications, where they will tell you whether such a service is included in the Moscow city compulsory medical insurance program.
Be aware that it is much easier to decide whether your treatment is free of charge before you pay, than to prove later that you paid not voluntarily, but under duress!
Question:
We are Muscovites, we have compulsory medical insurance policies. Our daughter (she is 4 years old) was found serious disease heart about which it is required expensive treatment... Our family is unable to pay for it from own funds... Can such medical assistance be provided to her free of charge and how can it be done?
Answer:
Expensive (high-tech) types of medical care are not included in the compulsory health insurance program and are not funded from the CHI funds.
In accordance with the Program of state guarantees for the provision of free medical care to citizens of the Russian Federation for 2007, high-tech medical care for citizens of Russia can be provided at the expense of federal budget, or funds from the budget of the constituent entity of the Russian Federation.
On the issue of organizing the free provision of expensive (high-tech) medical care for your daughter, we recommend that you contact the Moscow City Health Department, which is in charge of considering and resolving such issues, having with you all the necessary medical documentation for the child (Reception of the population: 2nd Schemilovsky per., 4-A, building 4 (Mon - Thu from 09.00 to 18.00, Fri from 09.00 to 16.45, lunch from 13.30 to 14.30).
Your daughter's medical documentation will be reviewed, if necessary, she will be consulted by appropriate specialists, after which a decision will be made to send her either to a federal clinic, where treatment will be carried out at the expense of the federal budget, or to a city medical and preventive institution, where your daughter will be treated. organized at the expense of the budget of the city of Moscow.
Question:
How can citizens be insured under compulsory medical insurance in case of refusal to receive medical care, charging fees for medical services that should be free of charge, poor-quality medical care, where can you go if such claims arise?
Answer:
The rights of citizens insured under compulsory medical insurance to receive free medical care are determined by the "Fundamentals of Legislation Russian Federation on the protection of the health of citizens "and the Law of the Russian Federation" On medical insurance of citizens in the Russian Federation ".
If the rights of a patient seeking medical care in the capital have been violated, he can apply:
To the leader or other official medical institution;
To the health department of the corresponding administrative district of Moscow;
To the Moscow Department of Health (Moscow, Oruzheiny Lane, 43);
* to an insurance medical organization that issued an OMI policy to the insured and, thus, took responsibility for protecting his rights;
* to the City Arbitration Expert Commission (GAEK) (if the patient's claims have already been considered by an insurance medical organization and have not been satisfied. Applications for transfer to GAEK are accepted by the Office of the Organization of Compulsory Medical Insurance of the Moscow City Compulsory Medical Insurance Fund, tel. 952-93-21) ;
* to court.
Question:
Who can I contact for assistance if the attending physician at the district polyclinic refuses to send me for consultation and diagnostic tests in specialized medical institutions? I am a Muscovite, I have a compulsory medical insurance policy, and these medical services are included in the compulsory medical insurance program.
Answer:
You can contact the head of the department, the deputy chief physician for medical work, the chief physician and, if the issue is not resolved in the polyclinic, the health authorities of your administrative district (address and reference phones available at the clinic) and the Moscow Department of Health (Moscow, Oruzheiny Lane, 43, tel. 251-83-00), as well as the medical insurance organization that insured you under compulsory health insurance.
Question:
Tell me what to do if my 8-year-old daughter needs a specialist consultation, but a doctor of this profile in our children's polyclinic has now gone on a long vacation?
Answer:
In this case, the attending physician who has appointed the patient to consult a specialist for medical indications is obliged to issue a referral to another medical institution operating in the compulsory medical insurance system, where your child will receive the required consultation free of charge in a planned manner. In case of difficulty in providing advice, we advise you to contact the head of the department, the chief doctor of the polyclinic or his deputy, the health department of the administrative district (its phone number and address can be found in the clinic's registry), as well as the medical insurance organization that issued your daughter's policy.
Question:
What are the obligations of an insurance medical organization in relation to citizens insured by it under compulsory health insurance?
Answer:
These obligations are determined by the Law of the Russian Federation "On Health Insurance of Citizens in the Russian Federation". These include: the conclusion of contracts with medical institutions for the provision of medical care to the insured under the compulsory medical insurance; issuance of medical insurance policies; control of the volume, timing and quality of medical care and protection of the interests of the insured.
According to clause 6.8 of the Rules for compulsory medical insurance of the population of Moscow, approved by the Decree of the Moscow Government dated 26.02.2002. No. 141-PP (as amended on November 25, 2003), an insurance medical organization is also obliged to familiarize citizens who receive an MHI policy from it with the current MHI program, the rights of the insured to receive medical care, the obligations of an insurance medical organization and a medical institution in relation to the insured. If you have not been provided with such information, you can find it out in the CMO reference and information service (the address and phone numbers are indicated on your compulsory medical insurance policy), at the points of issue of policies in the polyclinic.
Based on personal written requests from the insured, health insurance organizations carry out an examination of the quality of medical care provided under the Moscow City MHI Program.
Question:
Who is eligible to receive a compulsory medical insurance policy in Moscow?
Answer:
In accordance with current Regulations compulsory medical insurance of the population of the city of Moscow No. 141-PP, approved by the Decree of the Moscow Government dated 26.02.2002. (as amended on November 25, 2003), policies in the capital are issued by medical insurance organizations to citizens of the Russian Federation, foreign citizens and stateless persons who live in the city of Moscow; as well as citizens of the Russian Federation who do not have a place of residence in the city of Moscow, foreign citizens and stateless persons working at Moscow enterprises (or in their separate subdivisions in other territories of the Russian Federation) on the basis of relevant agreements.
Policy Mandatory health insurance is a system that allows you to receive most medical services free of charge in any region. It works as follows: every month everyone who works in the Russian Federation makes contributions to the Mandatory Health Insurance Fund. These funds go to medical insurance organizations operating in the compulsory medical insurance system. And they already pay for the work of employees of polyclinics, hospitals, dispensaries and other medical organizations - according to the number of patients served and the services provided to them.
In order for you to receive medical services free of charge, you must confirm that you are in the CHI system. This can be done by presenting a compulsory medical insurance policy.
"> Compulsory health insurance (MHI) - a document confirming your right to free medical care in state medical institutions throughout Russia.2. How to get a compulsory medical insurance policy?
To issue an OMS policy, you will need:
- passport or temporary identity card, if you change it;
- insurance number of an individual personal account (SNILS).
If you are applying for a policy for a child, you will need:
- application (to be filled in at the reception);
- birth certificate of a child;
- a document confirming that you can represent the interests of the child: your passport, act of the guardianship and guardianship authority on the appointment of a guardian or curator, a court decision, and so on;
- SNILS of a child (for children under 14 years old - if available, for children over 14 years old - mandatory).
If your representative will submit the documents, you will additionally need for registration:
- representative's passport or temporary identity card, if he changes it;
- power of attorney for insurance in the selected organization.
OMS policy can also be issued To issue a policy OMS to a foreigner you will need:
- application (to be filled in at the reception);
- the passport foreign citizen or another document recognized in the Russian Federation as certifying the identity of a foreign citizen in accordance with an international treaty;
- a residence permit for permanent residents of Russia or a mark on a permit for temporary residence in the Russian Federation in the passport of a foreign citizen or in another identity document for temporarily residing in Russia;
- SNILS (if available).
- application (to be filled in at the reception);
- a document recognized in the Russian Federation as certifying the identity of a stateless person in accordance with an international treaty, or a document issued in the Russian Federation to a stateless person who does not have identity documents;
- a residence permit for permanent residents of Russia or a mark on a permit for temporary residence in the Russian Federation in an identity document for temporarily residing in Russia;
- SNILS (if available).
- application (to be filled in at the reception);
- one of following documents: refugee certificate, certificate of consideration of the application for recognition as a refugee, a copy of the complaint against the decision to revoke the refugee status to the Federal Migration Service with a note of acceptance for consideration, certificate of temporary asylum on the territory of the Russian Federation.
You can submit documents to an insurance medical organization from the register of the Moscow City Fund of Compulsory Medical Insurance. Citizens of the Russian Federation registered in Moscow (both adults and children), who have never received a compulsory medical insurance policy before, can apply for a policy both in an insurance company and in any center of public services, regardless of the area of registration.
Please note: before the birth of the child and within 30 days thereafter, the child's health insurance is provided by the same insurance company in which his mother or other legal representative is insured. After this period, one of the parents or another legal representative may choose another insurance company for the child.
The compulsory medical insurance policy will be ready within 30 working days after the registration of the application and the documents you submitted. For this time, on the day of contact, you will be given a temporary policy, which you can use as usual.
3. How to change or restore the compulsory medical insurance policy?
If you are satisfied with your insurance company, you need to change the compulsory medical insurance policy or draw up a duplicate of it in cases when:
- you have changed your place of residence, full name or other data in your identity document - within a month;
- you discovered an inaccuracy in the personal data specified in the document;
- you have a policy Compulsory medical insurance of the old sample (green A4 sheet or plastic card), and you want a document of a new sample (blue A5 sheet or three-color plastic card);
- you have spoiled or lost your compulsory medical insurance policy.
To replace or obtain a duplicate of the policy, you will need the same documents as for the initial registration. If your personal data, place of residence have changed, or inaccuracies in the issued MHI policy have been found, you will also need documents confirming this.
You need to contact your insurance company. IN
If you want to change the insurer, you need to apply for a new policy to the organization you like. But note that by general rule you can change the insurance company no more than once a year. If you have changed your place of residence or your insurance company has ceased operations - as often as possible. At the same time, from November 1 to December 31, applications to change the insurance company will not be accepted.
Within 30 days after the registration of the application and documents you submitted, you will be issued a new compulsory medical insurance policy (old-style policies are no longer issued). During this time, you will be given a temporary policy, which you can use as usual.
4. Can I get an OMS policy online?
Adult users of the Official Website of the Mayor of Moscow website with a complete (confirmed) account in which in personal account SNILS is indicated.
To issue (replace, restore) an OMS policy online, you will need:
- scanned copy of an identity document;
- Black and white photograph of 320x400 pixels, up to 5 Mb in format: JPG, JPEG, JPE. "> Photo(when ordering a compulsory medical insurance policy in the form plastic card with electronic media)
- A scanned copy of the signature in black and white, 160x736 pixels in size, up to 5 Mb in the format: JPG, JPEG, JPE. The size of a handwritten signature should not exceed 10x46 mm. "> Scanned copy of the signature(when ordering an OMS policy in the form of a plastic card with an electronic carrier);
- OMS policy number (if any).
After you submit the documents, a temporary certificate will be available for download in your personal account. The OMS policy itself will be ready within 30 days after the registration of the submitted documents. You can get it at your chosen point of issue of policies of an insurance medical organization or in the center of public services (depending on which method of obtaining you indicate when submitting documents).
5. How can I check if my compulsory medical insurance policy is valid?
6. What medical services can be obtained free of charge under the compulsory medical insurance policy?
Under the compulsory medical insurance policy throughout Russia (regardless of where it is issued), you can get free of charge Medical services are provided in medical organizations involved in the implementation territorial programs Compulsory health insurance, in the amount established by the basic program of compulsory health insurance.
