According to the legislation in force in the Russian Federation, a medical insurance policy (CHI) is valid throughout Russia, and not just in the city where it was issued. Therefore, refusal to serve a citizen because his policy would be registered in another region is illegal and a direct violation of the law. How is service provided under a compulsory medical insurance policy in another city, what law is it regulated, and what consequences await a medical institution in the event of a refusal to provide services? We will try to answer these questions in detail in this article.
Procedure for servicing non-resident citizens
In order to use compulsory medical insurance in another city, you can go to any public clinic or hospital. In this case, the guarantor of a citizen’s right to free qualified service will be a document certifying the availability of insurance, namely a policy. You just need to present it when visiting a medical facility.
Note! According to the law, urgent and emergency assistance should be provided to everyone in need in any case, regardless of the presence of insurance, passport, etc. In such a situation, the medical institution simply does not have the right to demand any documents.
If a patient from another region is forced to pay for the service provided, then be sure to keep all receipts and receipts for treatment. Upon returning to your locality of permanent residence, you will need to contact the local territorial compulsory medical insurance fund and report the fact of an illegal demand for payment for medical services, after which, based on the receipts provided, the expenses will be reimbursed. If a citizen has forgotten the policy, then in another city he will also be able to use free medical care, but for this, either he personally or an employee of a health care institution will have to contact the territorial fund that issued the insurance document and find out information about the availability of the policy.
What law governs the compulsory medical insurance policy?
The principle of operation and procedure for the validity of the compulsory medical insurance document on the territory of the Russian Federation is regulated by Law No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens” adopted in 2011. As mentioned above, according to this law, a citizen has the right to use medical care even if the policy was obtained in another city. Moreover, in such a situation, the patient may encounter a number of features of the insurance policy. First of all, we are talking about the fact that, being outside his home region, he can count on a slightly different volume of services, since such patients are served in accordance with the basic health insurance program established by law.
The list of services included in this program is described in detail and regulated in Law No. 326-FZ of November 29, 2010. Summarizing this document, we can say that the basic program is somewhat smaller in terms of the volume of included services than the territorial one (more expensive diagnostics, procedures and operations are included here), however, in both cases the patient can be sure that he will receive highly qualified medical care.
Liability for denial of service
In a situation where a citizen does not want to be served at a healthcare institution on the grounds that the policy was issued in another city, it is worth immediately writing an application addressed to the head physician of this organization. In most cases, this is more than enough for the clinic staff to change their decision and provide the necessary assistance. If this scenario cannot be realized, you can call directly the insurance company (at the phone number indicated on the policy) or the territorial compulsory medical insurance fund.
Note! Medical services under the policy are provided only by those organizations that are included in the territorial compulsory medical insurance program. That is, if a person went to some private clinic (not included in the compulsory medical insurance) without needing emergency medical care (for example, he just caught a cold), then it is likely that no one will see him for free.
According to the law, employees of medical institutions of the compulsory medical insurance system do not have the right to refuse to provide assistance to a patient due to a discrepancy in the region. In case of refusal of service, the patient has every right to go to court and demand compensation not only for treatment costs, but also for moral damages. And if, through the fault of a medical worker who did not provide timely medical care to a patient, harm was caused to the patient’s health, the doctor faces criminal liability.
What tests are required to be done free of charge under the compulsory medical insurance policy, why get a new policy and is it valid outside the region of residence? Experts from the Compulsory Medical Insurance Fund for Tatarstan answer these and other questions.
The map is more convenient
The clinic said that the policy in the form of a booklet, received in 2010, was outdated. How urgently do you need to change it to a new one?
Dilia Magsumova, head of the department for the organization of compulsory medical insurance of the territorial compulsory medical insurance fund of the Republic of Tajikistan, answers:
Dilia Magsumova answered readers' questions. Photo: AiF
You should try to get a new policy on paper or in the form of a plastic card as soon as possible, although the expiration dates for old policies have not been established, and they continue to be valid in clinics and hospitals operating in the field of compulsory medical insurance.
- How to get a new policy?
Dilia Magsumova: It is necessary to select a medical insurance organization that provides compulsory medical insurance on the territory of the republic (there are three of them in Tatarstan - AK BARS-Med, Salvation and Chulpan-Med) and apply there, taking your passport and certificate of compulsory pension insurance (SNILS).
A citizen can also contact an insurance company through a representative acting on the basis of a power of attorney. In this case, the representative must have a power of attorney, as well as the passport and documents of the person he represents. For minor children, parents receive the policy. In this case, along with the child’s documents, the parent’s documents are also presented.
When submitting an application, the medical insurance organization issues the citizen a temporary certificate, then within a month the policy itself is prepared at Goznak JSC. The completed document is also issued by the insurance company. Policy issuance points are located in all cities and regional centers of the republic. More information about this can be found on the website www.fomsrt.ru or by calling the compulsory medical insurance contact center at 8-800-200-51-51.
They say that now, instead of a paper one, you can issue an electronic (plastic) compulsory medical insurance policy. How to do this and how is it different?
D.M.: To obtain such a policy, you must present the same documents as for obtaining a paper policy. Due to the fact that the plastic policy contains a photograph and personal signature of the citizen, an application for its receipt must be submitted in person. An electronic policy is a plastic card; it has a chip with information about the owner, but there is no big difference in functionality for a citizen. A more convenient format was introduced due to numerous requests.
You can also get acquainted with the appearance of the policies, policy issuing points where applications for their issuance are accepted (not all are equipped with special equipment), on our website www.fomsrt.ru. The production of plastic policies is carried out by JSC Goznak.
The electronic compulsory medical insurance policy is more convenient. Photo: Salvation
Will they accept the policy everywhere?
A relative lives in the Komi Republic and plans to come visit for 3 weeks. At the local clinic they said that the Komi policy is not valid in the Republic of Tatarstan, you need to get a policy here. Is it so? Do I need to change insurance company?
D.M.: A compulsory medical insurance policy issued in any region is valid throughout the Russian Federation. If you are refused to provide free medical care under such a policy, you must contact the head physician of the medical organization or call the compulsory medical insurance contact center of the Republic of Tajikistan (8-800-200-51-51). The medical insurance organization needs to be changed only if you change your permanent place of residence to another region within a month.
How to change clinic
Two years ago I was in Kazan City Hospital No. 11. There they refused to perform hemodialysis for me, which I believe was unreasonable. My sisters were forced to take me to Moscow for treatment. How can I restore justice? V. Dashchenko, Kazan
Answers Olga Polyakova, head of the department for protecting the rights of insured citizens of the Federal Compulsory Medical Insurance Fund of the Republic of Tajikistan:
Write a written statement to your insurance company. The examination of the quality of medical care is carried out using primary medical documentation. If violations are detected, financial sanctions will be applied to the medical organization. But it is better to contact the insurance company while receiving medical care.
We vacationed in Sochi in the summer. My father’s blood pressure rose and he was taken by ambulance to the hospital. The compulsory medical insurance policy remained in Kazan. And although they provided assistance, they said that the original document was required, and a fax with data from the insurance company was not enough. Are the doctors right?
O.P.: Yes, they are right, because when applying for medical care under compulsory medical insurance programs, a citizen is required to present a compulsory medical insurance policy and a passport or other identification document, with the exception of cases of emergency care. Therefore, when traveling outside your permanent place of residence, you need to take your compulsory medical insurance policy with you.
What to do if hospital doctors do not prescribe serious treatment for severe pain and do not send you to a republican hospital?
O.P.: The patient can contact the hospital management to organize a meeting of the medical commission, where controversial issues can be resolved. You have the right to have a consultation, when several doctors discuss the diagnosis and further treatment tactics. In addition, you can contact the insurance company to conduct a face-to-face examination of the quality of medical care.
- The doctor ordered a blood test and an ultrasound, but they were scheduled for only three days later. Did they have the right?
O.P.:The program of state guarantees of free medical care to citizens has established a waiting period for planned diagnostic and laboratory tests - no more than 14 calendar days from the date of their appointment. The volume, location and timing of diagnostic studies are determined by the attending physician.
- Can I choose a clinic of my own choosing?
O.P.: Yes, you have the right to do so. To do this, you must write an application addressed to the chief physician of the selected medical organization. At the same time, it is allowed to assign citizens living outside the service area of a medical organization to local doctors. If the number of attached persons exceeds the recommended standard, the clinic may refuse to assign. At the same time, a medical organization that provides primary health care on a territorial-precinct basis does not have the right to refuse to assign a citizen to his place of actual residence.
Do I need to pay for the analysis?
I came to the clinic with abdominal pain and bleeding. Pregnancy was suspected. They sent me for a paid hCG test. Do doctors have the right to do this?
O.P.: Determination of the concentration of human chorionic gonadotropin in the blood is included in the list of diagnostic measures during examination in the first trimester of pregnancy, provided for by the Procedure for the provision of medical care in the field of obstetrics and gynecology, approved by order of the Ministry of Health of Russia dated November 1, 2012 No. 572n. Therefore, the study should be carried out free of charge, including at the first visit if pregnancy is suspected. If the antenatal clinic offers to take a test for a fee, you must contact the medical insurance organization that issued the compulsory medical insurance policy (the telephone number is indicated in the policy), or the contact center of the Federal Compulsory Medical Insurance Fund of the Republic of Tajikistan by phone 8-800-200-51-51.
Compulsory medical insurance policy is a document that guarantees your right to receive free medical care throughout Russia.
This means that wherever you are in the Russian Federation, you can always go to any free medical institution, be it an emergency room or a dental clinic, and receive free medical care there. Therefore, when traveling anywhere outside your city, be sure to take the policy with you.
Providing the population with free medical care, the government controls this process with the help of compulsory medical insurance policies. Roughly speaking, thanks to the policies, the state knows how many working and non-working citizens, children, old people, men and women we have who need medical care from time to time. Based on these data, the state provides the population with the necessary number of clinics, hospitals, doctors, medical equipment and other things important for health. If you do not have a compulsory medical insurance policy, you will still receive emergency medical care. Since obtaining insurance policies is mandatory for everyone, you were also taken into account, and this help was counted on you.
How to get a compulsory medical insurance policy
To obtain a compulsory medical insurance policy, you need to contact the insurance company yourself, or do it through your employer. Compulsory medical insurance policies are available to all Russian citizens with the exception of military personnel. Military personnel have their own system of providing medical care. Foreigners who permanently or temporarily reside in Russia, refugees and members of their families are not issued a compulsory medical insurance policy. The exception is foreign narrow specialists who, as part of their hiring, receive a high salary of 2 million rubles or more per year. By law, you can choose your own insurance company; for about three years now, you can do this at your place of residence, and not just at your registration. Be responsible when choosing an insurance company; no one wants you to have problems in such an area as your health. If you are not satisfied with your insurance company in any way, you can change it by simply writing an application to the new insurance company. But you can do this no more than once a year. Today the government has further simplified the task of obtaining compulsory medical insurance policies. Now they have a single form, that is, if you change the insurance company, you do not have to change the policy itself.
To obtain a compulsory medical insurance policy, you must contact the insurance company and present them with the following documents: passport or temporary identity card, SNILS, as well as an application for a policy. If the policy is needed for a child under 14 years of age, then it is necessary to provide his birth certificate, as well as the passport of the legal representative.
What do we have the right to with compulsory medical insurance?
- Firstly, we have the right to obtain a compulsory medical insurance policy for free from any insurance company;
- Secondly, the insurance company must carefully instruct us about what we are entitled to with this policy.
Namely, with the compulsory medical insurance program operating on the territory of our state, our rights that we acquire along with the policy, the responsibilities that all medical institutions must observe in relation to us, and also tell us where to go if our rights are violated .
So, having a compulsory health insurance policy, we have the right:
- Receive free medical care in any free medical or treatment institution operating on the territory of the Russian Federation;
- Choose an insurance company once a year, choose a clinic and a doctor who will treat us, find out from the insurance company all the information regarding our compulsory medical insurance policy and the conditions of its validity, as well as to protect our rights if they are violated in the scope of the policies compulsory health insurance.
Compulsory medical insurance policies of a new type have been in effect on the territory of the Russian Federation for several years now. During the exchange, the recipient was immediately offered a choice of two types of documents: the usual paper and convenient plastic.
If the first one was actually completely similar to its predecessor, and therefore there were no questions about its use.
The second one was strikingly different, and not only in appearance.
1. A plastic card is convenient both due to its size and the possibility of long-term use. Thanks to it, you can forget about queuing at the registration window and make an appointment online. The built-in chip allows you to record all the necessary information about the owner without fear of losing it later.
2. On the front side there are:
name of the document and coat of arms of the Russian Federation;
microchip with information about the insurance company and the insured person;
sixteen digit code.
A seal informing about the name of the insurance company branch and its contact details is located to the right of the chip.
3. On the reverse side are:
TFOMS contact phone number, signature of the policy owner, POMS badge;
hologram confirming authenticity;
metric data of the owner, his photo, serial number and validity period of the policy.
4. This type of policy is compact in size and can easily fit into a compartment of a wallet or business card holder.
The main advantage of the electronic version of the policy is its compactness and durability.
The remaining advantages are not available to all owners, because special reading equipment and software are not available in all medical institutions.
Rules for replacement and use
You can replace a paper copy with an electronic one completely free of charge. In addition to photography, the policy has several more levels of fraud protection.
1. The first question that arises among people receiving an electronic compulsory medical insurance policy is: “Why a PIN code?” Of course, its main function is to protect information about the insured person. Thanks to this policy, you can resolve any issues that arise with a doctor and make an appointment with him through your personal government services account or terminal.
2. The second question is caused by the small amount of information among the population about changing this type of policy. After all, not all insurance companies are engaged in issuing it and, naturally, replacing it:
If personal data changes, the chip cannot be rewritten. It cannot be formatted and therefore the card will need to be replaced;
the procedure for issuing a new policy, as well as replacing an old one, takes the same amount of time as issuing a paper document.
Information about insurance companies providing services in medical institutions is available in local clinics.
3. To replace an old-style document with a new plastic one, you must personally visit representatives of the insurance company, write an application and submit the available documents for consideration. The production time on average takes 1.5 weeks, but the maximum period allowed by law is a month.
Along with the card, a PIN code is issued, which is necessary to confirm the personal presence of the owner when entering information. In addition, the person receives a pack code, which will be required if the PIN code is entered incorrectly.
What tests are required to be done free of charge under the compulsory medical insurance policy, why get a new policy and is it valid outside the region of residence? Experts from the Compulsory Medical Insurance Fund for Tatarstan answer these and other questions.
The map is more convenient
The clinic said that the policy in the form of a booklet, received in 2010, was outdated. How urgently do you need to change it to a new one?
Dilia Magsumova, head of the department for the organization of compulsory medical insurance of the territorial compulsory medical insurance fund of the Republic of Tajikistan, answers:
You should try to get a new policy on paper or in the form of a plastic card as soon as possible, although the expiration dates for old policies have not been established, and they continue to be valid in clinics and hospitals operating in the field of compulsory medical insurance. Select a medical insurance company and receive a new policy.
An electronic policy - in the form of a plastic card - has a chip with information about the owner, but for a citizen there is no big difference in functionality. A more convenient format was introduced due to numerous requests.
How to get a new policy?
Dilia Magsumova: It is necessary to choose a medical insurance organization that provides compulsory medical insurance on the territory of the republic (there are three of them in Tatarstan - “AK BARS-Med”, “Salvation” and “Chulpan-Med”) and go there, taking your passport and certificate of compulsory pension insurance ( SNILS).
A citizen can also contact an insurance company through a representative acting on the basis of a power of attorney. In this case, the representative must have a power of attorney, as well as the passport and documents of the person he represents. For minor children, parents receive the policy. In this case, along with the child’s documents, the parent’s documents are also presented.
When submitting an application, the medical insurance organization issues the citizen a temporary certificate, then within a month the policy itself is prepared at Goznak JSC. The completed document is also issued by the insurance company. Policy issuance points are located in all cities and regional centers of the republic. More information about this can be found on the website www.fomsrt.ru or by calling the compulsory medical insurance contact center at 8-800-200-51-51.
They say that now, instead of a paper one, you can issue an electronic (plastic) compulsory medical insurance policy. How to do it and how it differs.
D.M.: To obtain such a policy, you must present the same documents as for obtaining a paper policy. Due to the fact that the plastic policy contains a photograph and personal signature of the citizen, an application for its receipt must be submitted in person.
You can also get acquainted with the appearance of the policies, policy issuing points where applications for their issuance are accepted (not all are equipped with special equipment), on our website www.fomsrt.ru. The production of plastic policies is carried out by JSC Goznak.
Will they accept the policy everywhere?
D.M.: A compulsory medical insurance policy issued in any region is valid throughout the Russian Federation. If you are refused to provide free medical care under such a policy, you must contact the head physician of the medical organization or call the compulsory medical insurance contact center of the Republic of Tajikistan (8-800-200-51-51). The medical insurance organization needs to be changed only if you change your permanent place of residence to another region within a month.
How to change clinic
Two years ago I was in Kazan City Hospital No. 11. There they refused to perform hemodialysis for me, which I believe was unreasonable. My sisters were forced to take me to Moscow for treatment. How can I restore justice? V. Dashchenko, Kazan
Write a written statement to your insurance company. The examination of the quality of medical care is carried out using primary medical documentation. If violations are detected, financial sanctions will be applied to the medical organization. But it is better to contact the insurance company while receiving medical care.
We vacationed in Sochi in the summer. My father’s blood pressure rose and he was taken by ambulance to the hospital. The compulsory medical insurance policy remained in Kazan. And although they provided assistance, they said that the original document was required, and a fax with data from the insurance company was not enough. Are the doctors right?
O.P.: Yes, they are right, because when applying for medical care under compulsory medical insurance programs, a citizen is required to present a compulsory medical insurance policy and a passport or other identification document, with the exception of cases of emergency care. Therefore, when traveling outside your permanent place of residence, you need to take your compulsory medical insurance policy with you.
What to do if hospital doctors do not prescribe serious treatment for severe pain and do not send you to a republican hospital?
O.P.: The patient can contact the hospital management to organize a meeting of the medical commission, where controversial issues can be resolved. You have the right to have a consultation, when several doctors discuss the diagnosis and further treatment tactics. In addition, you can contact the insurance company to conduct a face-to-face examination of the quality of medical care.
The doctor ordered a blood test and an ultrasound, but they were scheduled for only three days later. Did they have the right?
O.P.: The program of state guarantees of free medical care to citizens sets a maximum waiting period for planned diagnostic and laboratory tests - no more than 14 calendar days from the date of their appointment. The volume, location and timing of diagnostic studies are determined by the attending physician.
Can I choose a clinic of my own choosing?
O.P.: Yes, you have the right to do so. To do this, you must write an application addressed to the chief physician of the selected medical organization. At the same time, it is allowed to assign citizens living outside the service area of a medical organization to local doctors. If the number of attached persons exceeds the recommended standard, the clinic may refuse to assign. At the same time, a medical organization that provides primary health care on a territorial-precinct basis does not have the right to refuse to assign a citizen to his place of actual residence.
Do I need to pay for the analysis?
I came to the clinic with abdominal pain and bleeding. Pregnancy was suspected. They sent me for a paid hCG test. Do doctors have the right to do this?
O.P.: Determination of the concentration of chorionic gonadotropin in the blood is included in the list of diagnostic measures during examination in the first trimester of pregnancy, provided for by the Procedure for the provision of medical care in the field of obstetrics and gynecology, approved by order of the Ministry of Health of Russia dated November 1, 2012 No. 572n. Therefore, the study should be carried out free of charge, including at the first visit if pregnancy is suspected. If the antenatal clinic offers to take a test for a fee, you must contact the medical insurance organization that issued the compulsory medical insurance policy (the telephone number is indicated in the policy), or the contact center of the Federal Compulsory Medical Insurance Fund of the Republic of Tajikistan by phone 8-800-200-51-51.
