b) on the territory of the subject Russian Federation, in which the policy of compulsory health insurance was issued, in the amount established by the territorial compulsory health insurance program;

2) the choice of an insurance medical organization by submitting an application in the manner, established by the rules compulsory health insurance;

3) replacement of an insurance medical organization in which a citizen was previously insured, once during a calendar year no later than November 1, or more often in the event of a change of residence or termination of the contract on financial support of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance, by submitting an application to a newly selected medical insurance organization;

4) selection of a medical organization from medical organizations participating in the implementation of the territorial compulsory health insurance program in accordance with the legislation in the field of health protection;

5) the choice of a doctor by submitting an application personally or through his representative addressed to the head of a medical organization in accordance with the legislation in the field of health protection;

6) obtaining from the territorial fund, medical insurance organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care;

7) protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance;

8) compensation by an insurance medical organization for damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize the provision of medical care, in accordance with the legislation of the Russian Federation;

9) compensation by a medical organization for damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize and provide medical care, in accordance with the legislation of the Russian Federation;

10) protection of rights and legitimate interests in the field of compulsory health insurance.

2. The insured persons are obliged to:

1) present a policy of compulsory medical insurance when applying for medical care, except for cases of emergency medical care;

2) submit to an insurance medical organization, personally or through a representative, an application for choosing an insurance medical organization in accordance with the rules of compulsory medical insurance;

3) notify the medical insurance organization about the change in the last name, first name, patronymic, data of the identity document, place of residence within one month from the day when these changes occurred;

4) make a choice of an insurance medical organization at a new place of residence within one month in the event of a change of residence and the absence of an insurance medical organization in which the citizen was previously insured.

3. Compulsory health insurance for children from the day of birth until the expiration of thirty days from the date state registration birth is carried out by an insurance medical organization in which their mothers or other legal representatives are insured. After thirty days from the date of state registration of the birth of a child and until he reaches the age of majority or until he acquires legal capacity in full, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or other legal representative.

4. The choice or replacement of an insurance medical organization is carried out by an insured person who has reached the age of majority or acquired legal capacity in full (for a child until he reaches the age of majority or until he acquires legal capacity in full - by his parents or other legal representatives), by submitting an application to the medical insurance an organization from among those included in the register of medical insurance organizations, which is located in mandatory by the territorial fund on its official website on the Internet and may additionally be published in other ways.

5. To select or replace an insurance medical organization, the insured person personally or through his representative applies with an application for selection (replacement) of an insurance medical organization directly to an insurance medical organization or other organizations of his choice in accordance with the rules of compulsory medical insurance. On the basis of this application, the insured person or his representative is issued a policy of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance. If the insured person has not submitted an application for the choice (replacement) of an insurance medical organization, such a person is considered insured by the insurance medical organization with which he was previously insured, except for the cases provided for in paragraph 4 of part 2 of this article.

6. Information about citizens who have not applied to an insurance medical organization for the issuance of compulsory medical insurance policies to them, as well as who have not replaced the insurance medical organization in the event of termination of the contract on financial support of compulsory medical insurance in connection with the suspension, revocation or termination of the license of medical insurance organizations, monthly by the 10th day, are sent by the territorial fund to medical insurance organizations operating in the field of compulsory health insurance in the constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them to conclude agreements on the financial support of compulsory health insurance. The ratio of working citizens and non-working citizens who did not apply to an insurance medical organization, as well as who did not replace an insurance medical organization in the event of termination of the contract on financial support of compulsory medical insurance in connection with the suspension, revocation or termination of the license of an insurance medical organization, which is reflected in the information sent to medical insurance organizations should be equal.

7. Insurance medical organizations specified in part 6 of this article:

1) within three working days from the date of receipt of information from the territorial fund, inform the insured person in writing about the fact of insurance and the need to obtain a compulsory medical insurance policy;

2) ensure the issuance of a compulsory medical insurance policy to the insured person in the manner prescribed by Article 46 of this Federal Law;

3) provide the insured person with information about his rights and obligations.

Judicial practice under Article 16 of the Federal Law dated November 29, 2010 No. 326-ФЗ

Appeal ruling dated December 24, 2019

Supreme Court of the Russian Federation - Administrative

Medical care within the scope of medical care allocated to the medical organization by the Commission. In support of the claim, the administrative plaintiff referred to the fact that the contested norm did not comply with Articles 16, 19, 20, 36, 37, 38 of the Federal Law of November 29, 2010 No. 326-FZ “On mandatory health insurance in the Russian Federation ", Articles 4, 10, 11, 19, 79 ...

Resolution of August 29, 2019 in case No. A29-12960 / 2018

Arbitration Court of the Komi Republic (AC of the Komi Republic)

About citizens who have not applied to an insurance medical organization for the issuance of compulsory medical insurance policies, received from the territorial fund in accordance with part 6 of Article 16 of Law No. 326-FZ. Clause 2.23 of the contract stipulates that an insurance medical organization undertakes to monitor the volume, timing, quality and conditions of providing medical care to insured persons in medical ...

Judgment of August 26, 2019 in case No. А22-2526 / 2019

Arbitration Court of the Republic of Kalmykia (AC of the Republic of Kalmykia) - Civil

The essence of the dispute: Other disputes - Civil

Provided to insured persons within the framework of the basic program of compulsory medical insurance to citizens insured in the territory of other constituent entities of the Russian Federation. According to the provisions of Article 1 of the Federal Law of 16. 07.1999 No. 165-FZ "On the basics of compulsory social insurance"(Hereinafter - Law No. 165-FZ) this Federal Law in accordance with the generally recognized principles and norms of international law regulates relations ...

Decision of August 26, 2019 in case No. А11-4166 / 2019

Arbitration Court of the Vladimir Region (AS of the Vladimir Region)

In accordance with this Federal law and an agreement on the financial support of compulsory health insurance, concluded between the territorial fund and an insurance medical organization. Articles 3, 4, 16, 20 of Law No. 326-FZ establish that OMS is a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring in the event of an insurance ...

Decision of August 26, 2019 in case No. A49-2501 / 2019

Arbitration Court of the Penza Region (AC of the Penza Region)

The court rejects the third party on the above grounds. Guided by Art. Art. 309, 310, 330, 779, 781 Civil Code Of the Russian Federation, since Art. 4, 14, 15, 16, 20, 33, 36, 37, 38, 39 of the Federal Law of 29.11.2010 No. 326-FZ "On Compulsory Health Insurance in the Russian Federation", Art. 11 of the Federal Law of 21 ....

"On compulsory health insurance in the Russian Federation" Federal Law of November 29, 2010 N 313-FZ "On Amendments to Certain Legislative Acts of the Russian Federation in Connection with the Adoption of the Federal Law" On Compulsory Health Insurance in the Russian Federation "* 1


_____
*1. The texts of the documents are not provided. The texts of all normative documents can be found on the website www.site.

A comment


L.P. Fomicheva
auditor, tax consultant

New Law on Compulsory Health Insurance


Medical insurance in the Russian Federation is provided in two types: compulsory and voluntary.

Compulsory health insurance (MHI) is an integral part of state social insurance and provides all Russian citizens with equal opportunities to receive medical and pharmaceutical care provided at the expense of MHI funds in the amount and on the terms of the relevant programs.

The current Law of the Russian Federation of June 28, 1991 N 1499-1 "On medical insurance of citizens in the Russian Federation" was adopted in difficult conditions. The need for its adoption was primarily due to insufficient budget financing Russian healthcare... The introduction of insurance made it possible to maintain the system health care population, to prevent a landslide drop in the level of financing of medical institutions and to begin a consistent reform of health care.

At the same time, many provisions of this Law do not work, since they are declarative in nature, are not supported by the material and technical condition of medical institutions and their funding necessary for their implementation. This led to the development of a new Federal Law, adopted by the State Duma on November 19 and approved by the Federation Council on November 24, 2010.

Federal Law of 29.11.2010 N 326-FZ (Further - Law N 326-FZ ) entered into force on January 1, 2011, except for the provisions that come into force on January 1, 2012. The purpose of the law is to strengthen the guarantees of citizens' rights to free medical care and to regulate relations arising in connection with the implementation of compulsory medical insurance.

Law N 326-FZ will allow gradually, during 2012-2014, to increase financing of health care, to ensure a balance of state guarantees for free medical care for the population with financial commitments state, to strengthen the material and technical base of health care and, as a result, to increase the availability and quality of medical care.

Article 4 of Law N 326-FZ the basic principles of compulsory health insurance are established: availability and quality of medical care; guarantees of free provision of medical care to the insured person within the framework of compulsory medical insurance programs, regardless of the financial situation of the insurer; autonomy of the financial system.

The legal status and powers of the Federal (FFOMS) and territorial (TFOMS) compulsory health insurance funds, medical insurance organizations and medical organizations in the CHI system have also been determined; their rights, duties and responsibilities; rights and obligations of insured persons and policyholders.

The relations concerning the financial support of compulsory health insurance have been settled: the procedure for the formation of compulsory medical insurance funds has been prescribed; the size of the insurance premium for the compulsory medical insurance of the non-working population; period, procedure and terms of payment of insurance premiums; responsibility for violations in the area of ​​their payment; the procedure for setting tariffs for paying for medical care under compulsory medical insurance; the procedure for the formation and spending of funds by an insurance medical organization.

Generally Law N 326-FZ regulates in sufficient detail the rights and obligations of all subjects and participants of compulsory health insurance, their relationship, provides for the modernization of compulsory health insurance and is aimed at the further development of health care.

Let's consider the main provisions of the Law in more detail.

Insured persons


V article 10 of Law N 326-FZ it was established that the insured persons are:

- citizens of the Russian Federation (working and non-working);

- foreigners permanently or temporarily residing in our country, and stateless persons (with the exception of highly qualified specialists and their family members in accordance with Federal Law of 25.07.2002 N 115-FZ "On legal status foreign citizens in the Russian Federation " );

Persons entitled to medical care in accordance with the Federal Law of 19.02.1993 N 4528-1 "On Refugees" .

Actually, these same persons were insured earlier, according to the previous legislation.

Foreigners, incl. citizens of the member states of the Commonwealth of Independent States permanently residing in the Russian Federation had the same rights and obligations in the field of health insurance as Russian citizens, unless otherwise provided by international treaties (Article 8 of Law No. 1499-1). Foreign citizens permanently residing in Russia include persons who have an appropriate permit and residence permit issued by the internal affairs bodies.

The income of foreign workers who had a temporary residence permit in Russia were subject to insurance premiums in 2010, so they were also entitled to medical assistance under the compulsory medical insurance policy.

Such workers could receive sick leave certificates in the polyclinic in case of temporary disability. This is confirmed by clause 1 of the Procedure for issuing certificates of incapacity for work by medical organizations, approved. by order of the Ministry of Health and Social Development of Russia dated 01.08.2007 N 514 : sick leave certificates are issued to citizens of Russia, as well as to foreigners with a residence permit or a temporary residence permit.

Foreign workers permanently or temporarily residing in the territory of the Russian Federation are entitled to receive benefits for temporary incapacity for work upon the occurrence of an appropriate insured event if they work under an employment contract ( Art. 2 of the Federal Law of December 29, 2006 N 255-FZ "On compulsory social insurance in case of temporary disability and in connection with motherhood" ).

A refugee and his family members who arrived with him have the right to medical and drug assistance on an equal basis with Russian citizens in accordance with federal law, unless otherwise provided by international treaties of the Russian Federation (sub. 7 clause 1 of Art. 8 of the Federal Law of 19.02.1993 N 4528-1 "On Refugees" ). Required condition- establishment by them by the bodies of the Federal Migration Service legal status refugee and issuance of the corresponding "ID card of the forced migrant".

Foreign citizens temporarily staying in the Russian Federation are not named in the new Law. They enter the territory of Russia according to valid documents and are required to register their foreign passports or documents replacing them with the internal affairs bodies in the prescribed manner and leave our country after a certain period of stay. The status of a temporary resident presupposes that a foreign citizen has a migration card, a document only confirming the right of a foreign citizen to stay on the territory of Russia (clause 1 of article 2 of Law N 115-FZ). Since 2010, the amounts of payments and other remuneration under labor and civil law contracts in favor of foreign citizens and stateless persons temporarily staying in the territory of the Russian Federation are not subject to insurance premiums ( sub. 15 p. 1 of Art. 9 of the Federal Law of 24.07.2009 N 212-FZ "On insurance contributions to Pension Fund Of the Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal Compulsory Health Insurance Fund and territorial compulsory health insurance funds " ; Further - Law N 212-FZ ). If a foreign citizen has the status of temporarily staying on the territory of Russia, he is not an insured person and, accordingly, for payments in his favor insurance premiums compulsory pension insurance is not charged. From Art. 2 of Law N 255-FZ It also follows that foreigners and stateless persons temporarily staying in the territory of Russia, since 2010, are not insured and do not have the right to receive mandatory social insurance coverage.

The law does not provide for the possibility of voluntary payment of insurance premiums by the employer for such citizens. If the company includes in the employment contract concluded with such an employee, the condition of payment to him sick leave and voluntary transfer of contributions, the FSS of Russia will not reimburse these benefits in any case. The letter of the Moscow regional branch of the MHIF dated January 29, 2010 N 04-03-11 / 652 explains: since such persons do not fall under the CHI, employers should not issue them CHI policies. If the policy has already been issued, the document must be returned to the insurance company.

Medical insurance for foreigners temporarily staying in Russia, incl. citizens of the CIS member states, carried out in the manner determined Decree of the Government of the Russian Federation of 11.12.1998 N 1488 "On medical insurance of foreign citizens temporarily staying in the Russian Federation and Russian citizens when leaving the Russian Federation" , which approved the Regulation on medical insurance of foreign citizens temporarily staying in the Russian Federation.

As a rule, such persons have the opportunity to receive free only emergency and emergency medical care for conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning and acute diseases). In this case, medical care is provided to them at the expense of budgets of all levels by medical and preventive institutions of the state and municipal health systems, as well as health workers or by persons obliged to provide first aid by law or special regulation. From the moment when the threat to the patient's life or the health of others is eliminated and the patient can be transported, the payment for the provided medical care is charged as planned.

Routine medical care of all types can be provided to citizens of this category only on the basis of voluntary health insurance or on a paid basis.

Unified insurance policy for all territories of Russia


One of the big disadvantages the existing system is the inability to receive medical care under the compulsory medical insurance policy, while in another region. Currently, the compulsory medical insurance policy is not the same for all regions of Russia. Each insurance company printed its own policies for its insured, which needed to be changed as it expired. When changing the place of work, the person was obliged to pass compulsory medical insurance policy employer and get a new one where he was employed. This took time, during which the employee, with whom wages contributions to the MHIF were paid, in fact, he had no opportunity to receive medical assistance. And when moving to the category of non-working, he had to get a policy from an insurance medical organization, which, according to the results of a competition, insured non-working citizens.

Formally, a citizen can still receive medical care under the compulsory medical insurance policy outside the place of registration. But hospitals and clinics most often, in violation of the current law, refuse to admit nonresident citizens and citizens living in another area of ​​the city. This happens for several reasons: firstly, no a single base insured, by which it would be possible to determine where the money for the patient will come from, and whether it will come. Secondly, in large regions, such as Moscow or St. Petersburg, the compulsory medical insurance program is much more expensive than in the country as a whole, hence the reluctance to accept "stranger" patients. In this regard, medical institutions often refuse to take into account the policies issued in other regions and try to treat nonresident only for money.

Law N 326-FZ provides for the development of basic and territorial CHI programs ( Art. 3 of Law N 326-FZ ). In chapter 7 The law specifies which types of assistance are included in each of them. Since 2013, emergency medical care has been included in the basic compulsory medical insurance program, and high-tech - since 2015 ( Art. 51 of Law N 326-FZ ). Programs are approved at the federal and regional levels, respectively. The basic program operates throughout the territory of Russia, and the territorial one - within the limits of the constituent entity of the Russian Federation. Subjects will have the right to add types of medical care and insured events that are not included in the CHI to the basic program, and finance them additionally.

For the realization throughout the territory of the Russian Federation of the rights of citizens to receive free medical care Law N 326-FZ the following is stipulated: starting from May 2011, citizens will be issued compulsory medical insurance policies of a single sample, guaranteeing free medical care under the basic compulsory medical insurance program in any region of the country, regardless of the place of residence of the insured (art. 45). On the territory of the constituent entity of the Russian Federation, where the compulsory medical insurance policy was issued, citizens can count on assistance in the amount of the territorial compulsory medical insurance program (Article 3). The policy may not be presented if emergency medical assistance is required (clause 2, article 16).

The replacement of issued and valid regional compulsory medical insurance policies for policies of a single sample will not be made in an emergency, but gradually (Article 51).

Until May 1, 2011, if necessary, old-style policies will be issued in the same manner, and from May 1, 2011 to January 1, 2012 - new policies of a single model. The electronic policy will be valid throughout Russia. Outwardly, "substitutes" for the usual paper documents resemble plastic cards with a chip and represent an electronic card of a single sample. This policy is designed for machine reading of patient information.

The new perpetual policy will be valid even if the person did not manage to get insured with the insurance company. It will serve as a guarantor of medical care in any region of the country, regardless of place of residence, and will be issued to everyone - both working citizens and the unemployed. Replacement of the policy is assumed only due to its loss or wear, change of the surname, name, patronymic of the insured. When changing an insurance medical organization, place of residence, status of the insured, replacement is not provided.

Polices Compulsory medical insurance of the old sample issued to persons insured under compulsory health insurance prior to entry into force Law N 326-FZ are valid until they are replaced with compulsory medical insurance policies of a single sample or universal electronic cards of a citizen of the Russian Federation. All medical institutions after January 1, 2011 are obliged to admit patients under the old policies.

The policies must be replaced if a person wants to change the insurance organization, or they expire, or in case of a change of residence. In order not to have problems with the provision of medical care, all citizens insured in the CHI system should look into the document and inquire about the expiration date of its validity. The complete replacement of old-style "paper" policies with electronic cards should be completed by January 1, 2014.

From January 1, 2012, the compulsory medical insurance policy will be included in the universal electronic citizen card in accordance with Federal Law of 27.07.2010 N 210-FZ "On the organization of the provision of state and municipal services" ( Art. 45 of Law N 326-FZ ).

Moscow will switch to a universal electronic card during 2011. She will begin to replace the compulsory health insurance policy and certificate for Muscovites pension insurance... In addition, with the help of this card, it will be possible to pay for travel in public transport and exercise your right to receive most public services. The new electronic document will retain all the possibilities that it provides today social card Muscovite.

From 2014 on the territory of Russia a single universal card"three in one", including a medical policy, a pension insurance policy, information about the benefits due to a person.

Of course, the new policies will allow citizens to receive the necessary assistance on vacation or on a business trip. At the same time, for the introduction in Russia of a unified electronic policy of a new type, special training is needed: special equipment for producing the document, and so that hospitals and polyclinics can "read" it.

For the first time, a strict norm is established by law on the timing of payments for medical care provided to patients. Medical institutions now have a guarantee of payment for assistance provided to a nonresident citizen, and now they will be interested in providing it.

In case of delay in payment, the medical insurance organization at the expense of own funds pays a fine to a medical organization in the amount of 1/300 of the refinancing rate The Central Bank RF, in effect on the day the delay occurred, from amounts not listed for each of its days ( clause 7 of Art. 39 of Law N 326-FZ ).

In addition to the unified medical policy, the possibility of replacing the usual paper stories diseases to electronic. To receive nonresident citizens, a doctor needs a history of his illness. After all, this person was not observed in the clinic, and most often he does not carry a medical history with him. If a medical history was automatically attached to a single policy, it would be great. Better yet, have your own treatment card online, in in electronic format... This is important, especially for those who often travel on business trips, travel. In this case, a doctor from any clinic in the country will be able to obtain all the information about the state of human health. At the same time, the diagnostic time is reduced, which, in some diseases, can save lives.

At the same time, in some European countries, the use of electronic maps in the global network is prohibited, because no reliable data protection. In addition, information posted on the Internet may become available not only to a doctor. And violation of confidentiality threatens to turn into a lawsuit against a medical institution.

Personalized medical records


The lack of a unified database of insured persons leads to the fact that the number of insured under compulsory medical insurance exceeds the number of Russian citizens.

In order to realize the rights of citizens to receive free medical care throughout the territory of the Russian Federation, it is planned to create a single information space, including all subjects and participants of compulsory medical insurance, and to introduce a personalized record of information about insured persons and the assistance provided to them ( ch. 10 of Law N 326-FZ ).

From January 1, 2011, the creation of a unified database will begin, which will allow citizens to receive medical care in any region of Russia. The electronic database of the insured will be created as they seek medical help, as well as replace old policies with new ones.

A single database will ensure the reliability and eliminate duplication of information about the insured. Within two years, the bulk of the insured will be included in this electronic database.

Ideally, thanks to the creation of a single information base, everyone will be able to make an appointment with a doctor without leaving home - from their home computer via the Internet.

Law N 326-FZ established the procedure for the implementation of personalized (individual) accounting in the CHI system, as well as procedures for interaction between medical, insurance medical organizations and the territorial fund in the system of personalized accounting of information about medical care provided to the insured person.

Determines the procedure for maintaining personalized records in the field of compulsory health insurance FFOMS ( Art. 7 of Law N 326-FZ ).

Article 16 of Law N 326-FZ establishes that insured persons have the right to the protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance.

In articles 47and 48The Law establishes the procedure for interaction between medical insurance and medical organizations with the TFOMI when maintaining personalized records of information about medical care provided to insured persons, in Art. 49- the procedure for interaction of the territorial body of the PFR with the TFOMS and insurers for non-working citizens.

In pursuance of this Law, Federal Law of 29.11.2010 N 313-FZ (Further - Law N 313-FZ ), making the appropriate changes to the personified (individual) accounting. We'll look at it separately.

The choice of an insurance company, clinic and doctor is up to the patient


The role of the insurance organization is somewhat different compared to the current system. Now the choice of the insurance organization remains with the insured, i.e. the employer for whom the person works, since he pays insurance premiums for the employee. Regional authorities provide insurance for unemployed people. As a result, it turns out that insurance companies have no motivation to fight for consumers of services.

According to Art. 16 of Law N 326-FZ a citizen gets the right to independently choose an insurance medical organization dealing with compulsory medical insurance. At the same time, the right to this of the employer and municipal authorities is excluded.

The choice can be made by a citizen who has reached the age of majority. From the day of birth to the day of registration of their birth, children are insured by organizations where their mothers or legal representatives are insured. After the child is registered and until the age of majority, he is insured by insurers who have been chosen by one of the parents or their legal representative.

If a person does not choose a company or does not submit an application for its change, it is considered that he is insured in the organization where the insurance was carried out earlier. The only exception is a change of residence. In this case, within a month, the citizen is obliged to choose new organization in the absence of the former insurer on this territory. A person must notify the insurer about a change of residence, surname, name, patronymic within a month.

If citizens have not chosen an insurer, the TFOMS sends information about them to insurers on a monthly basis until the 10th day. The division of the number of citizens between insurance companies is made in proportion to the number of insured persons in each of them, and the ratio of working and non-working citizens who have not applied to an insurance medical organization, which is reflected in this information, should be equal. Insurers who have received such information from TFOMS send a letter to the citizen. It confirms the fact of insurance in this organization and informs about the need to obtain an OMI policy.

The insured person will have the right to replace the chosen medical insurance organization with another one. Medical insurance organizations have no right to refuse such a choice.

However, one should not hope that the number of medical services depends on the choice - they will be the same in all companies. Everything Insurance companies will have contracts with all clinics in the compulsory medical insurance system. Insurance companies will perform intermediary functions, act as defenders of patients, defending their rights, and organize an independent examination of the services provided by doctors. Experts do not predict a massive transition from one company to another. Most likely, the majority will remain in companies where they are already insured.

As a rule, the desire to change the insurance company arises at critical moments when the patient realizes that in a difficult situation assistance was not provided in full, and the company was unable to protect his rights, i.e. has not fulfilled its basic obligations. The replacement of an insurance medical organization, where a citizen was previously insured, can be carried out once during a calendar year, but no later than November 1. More often - in the event of a change of residence or termination of the contract on financial support of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance - by submitting an application to a newly selected medical insurance organization with which he would like to cooperate. On the basis of this application, an OMI policy is issued to the insured person or his representative by the medical insurance organization.

Insurance organizations working with CHI will be tightly controlled. They are required to be stable in their activity. For this new law prescribes an increase authorized capital such companies doubled - from 30 to 60 million rubles. Insurance medical organizations are not entitled to carry out other activities, except for compulsory and voluntary medical insurance ( Art. 14 of Law N 326-FZ ).

Today medical institutions in most cases, they are supported by budgets of various levels. At the same time, they receive money regardless of how many patients were admitted and cured. And even more so regardless of the quality of the treatment.

The new Law changes this situation - the money will go after the patient, i.e. the service provided is financed, not the institution.

From the list of medical institutions working in the compulsory medical insurance system, citizens will be able to choose the hospital where they would like to receive help. Their list is available on the official websites of the territorial CHI funds. At the same time, a medical institution included in the register and having entered into an agreement for the provision of services under the compulsory medical insurance program has no right to refuse to provide assistance to the insured person.

Upon written application, the patient can choose the attending physician in accordance with the legislation of the Russian Federation (after all, the territorial principle of medical care, for example, is not canceled by the new Law). True, there is one caveat - with the consent of the doctor. If a person lives in one area of ​​the city, and wants to be treated by a doctor working in another area, you need to ask his consent - is he ready to go to the call across the city. Therefore, a doctor's home call will need to be made in the clinic serving the patient's territory. The right to choose a hospital becomes legal. The polyclinic doctor who is prescribing the referral will now have to listen to our wishes.

Another requirement of the new Law is that now all medical institutions must have their own sites on the Internet with detailed information.

If we assume that patients still get a real right to choose a clinic and a doctor, medical institutions will find themselves in a highly competitive environment. After all, the more patients, the more money the insurance company will pay the hospital.

The right to choose a doctor and a medical institution has long been enshrined in the Federal Laws "On the Protection of Citizens' Health" and "On Medical Insurance of Citizens in the Russian Federation", but in fact this does not happen. Most of the townspeople are treated according to the territorial principle: in the municipal clinic at the place of residence. And we are not talking about any choice of a medical institution, and even more so a doctor. Here it is appropriate to recall the birth certificates, which also gave expectant mothers the right to seek help from any maternity hospital that has free places. However, in reality, the promises turned out to be empty. Will the same situation be repeated now?

Fundamental innovation Law N 326-FZ lies in the fact that not only state (municipal) medical institutions, but also organizations of any organizational and legal form, as well as individual entrepreneurs in private medical practice ( Art. 15 of Law N 326-FZ ). The main thing is that they have the right (license) to carry out medical activities, they must be included in a special register of medical organizations and keep separate records for operations with compulsory medical insurance funds and other operations. The register of such organizations is maintained by the TFOMS and published on the Internet or in any other way. The register contains the name, address of medical organizations and the list of services provided by them within the framework of the territorial compulsory medical insurance program. The procedure for maintaining, the form and list of information in the register are established by the rules of compulsory health insurance.

Previously, "private traders" also worked with the local self-government bodies, but received special permission from the city administration for certain services. Now private clinics can simply register to join the system.

But here a reasonable question arises: will private clinics be interested in the scanty money that the MHIF departments pay for each citizen under the policy? Recall: the annual per capita standard for the state program for the provision of free medical care is 4059 rubles. 60 kopecks Nobody is going to revise it yet.

The tariffs for the compulsory medical insurance system are significantly lower than in private clinics, and it is prohibited by law to make a "discount" from the policy to patients. According to insurers, this is done to protect us from manipulation of consciousness. You should not expect that a person from the street can come with a policy and receive treatment. These clinics will be given a referral for a certain service under the state order. For example, the clinic will receive a government order for dental prosthetics for veterans. Then the pensioner will receive a referral to this clinic. The same will happen with complex operations or technologies. The compulsory medical insurance policy may be used by private clinics, but in complex treatment, where some of the services will be free, and some will be for decent money.

The Law more clearly spelled out the rights of medical insurance organizations to control the provision of medical care. Protection of the rights of the insured should become the basis in relations with consumers and include such parameters as the selection of a medical organization to provide care, management of its client at all stages of its provision and control over how it was provided. If a person comes with a policy to the hospital, and they begin to demand money from him for the services they are entitled to for free, he must first call his insurance company with the requirement to understand the situation. And the insurance company becomes a "lawyer" defending his rights. This is not bringing to court, but proceeding at the earliest stage of the conflict.

Article 16 of Law N 326-FZ gives patients the right to compensation for damage caused by medical insurance or medical organizations in connection with non-fulfillment or improper fulfillment of their obligations to provide medical care. Article 31 of Law N 326-FZ the procedure for such compensation in a situation where the damage is not related to a serious industrial accident has been determined. If the latter took place, you should contact Art. 32 of the Law , which found that after a serious injury at work should be treated at the expense of funds received by the FFOMS in accordance with Federal Law of 24.07.1998 N 125-FZ "On compulsory social insurance against accidents at work and occupational diseases"(Further - Law N 125-FZ ).

Unfortunately, our state is practically not engaged in educational activities in the field of patients' rights. We have almost no lawyers dealing with judicial practice on medical topics. In addition, there must be an institution of independent medical experts who cannot be influenced by the medical community. After all, this is the only way to give an independent opinion on the quality and correctness of treatment. So far, no one talks about such things, but for the correct receipt medical services we need to have information on hand that can challenge doctors' misconduct and prosecute those responsible. And for this you need to have a really working judicial mechanism, which, alas, does not exist today.

Chapter 9 of Law N 326-FZ a system of examinations of the quality of medical care is established - the identification of violations in the provision of medical care, incl. assessment of the correctness of the choice of medical technology, the degree of achievement of the planned result and the establishment of cause-and-effect relationships of the identified defects in the provision of medical care. It is indicated who can act as an expert. It was established that a medical organization does not have the right to prevent experts from accessing the materials necessary for conducting a medical and economic examination, an examination of the quality of medical care, and is obliged to provide experts with the requested information. The results of the examination are formalized by the relevant acts in the forms established by the FFOMS.

Based on the results of monitoring the volumes, terms, quality and conditions for the provision of medical care, the measures provided for Art. 41 of Law N 326-FZ and the terms of the contract for the provision and payment of medical care under compulsory medical insurance. In addition to non-payment for poor-quality care, the medical organization will compensate the patient for harm caused by its fault.

Financial security


The management structure of the CHI system is changing. The FFOMS is recognized as the insurer within the framework of the implementation of the basic CHI program, from 2012 all medical contributions... it non-profit organization created by the Russian Federation to implement public policy in the field of compulsory medical insurance ( Art. 12 of Law N 326-FZ ).

Chapter 5 of Law N 326-FZ the issues of financial support of compulsory medical insurance were settled (including the procedure for the formation of compulsory medical insurance funds); the procedure and terms for payment of insurance premiums have been determined; liability for violations in the area of ​​their payment has been established; the procedure for calculating tariffs for paying for medical care under compulsory medical insurance has been determined.

Compulsory medical insurance funds are formed at the expense of:

Income from payment of insurance premiums for compulsory medical insurance;

- arrears on contributions, tax payments;

- accrued interest and fines;

- funds federal budget transferred to the FFOMS budget in cases established by federal laws, in terms of compensation for lost income in connection with the establishment of reduced rates of insurance premiums for compulsory medical insurance; funds from the budgets of the constituent entities of the Russian Federation transferred to the budgets of the TFOMS in accordance with federal and regional legislation;

- income from the placement of temporarily free funds;

- other sources provided Russian legislation ( Art. 21 , 26and 27 of Law N 326-FZ ).

The procedure and conditions for the placement of temporarily free funds of the Federal and territorial CHI funds are established by the Government of the Russian Federation ( Art. 29 of Law N 326-FZ ).

For the first time in the Law, a norm appeared indicating that the funds of the CHI fund can be used not only in Russia, but also in medical institutions of foreign countries, but there is no specific information about what kind of medical institutions these will be.

Separate powers of the insurer will be exercised by TFOMI and medical insurance organizations ( Art. 13 and 14 of Law N 326-FZ ).

The legal status of FFOMS and TFOMS is defined in ch. 6 of Law N 326-FZ ... It is envisaged to strengthen the role of TFOMI as a controlling organization. Within the framework of his powers, he will conduct inspections targeted use compulsory medical insurance funds not only in insurance medical companies but also in medical organizations, as well as, independently of the insurer, to carry out all types of medical examinations of cases of treatment of insured citizens ( Art. 40 of Law N 326-FZ ). TFOMS is controlled and subordinated to FFOMS.

The Ministry of Health and Social Development of Russia has already developed a draft model provision on TFOMS, a draft departmental order of December 6, 2010 on its approval is presented on the official website of the ministry. According to the document, TFOMI is a non-profit organization created by a constituent entity of the Russian Federation to implement state policy in the field of compulsory health insurance in the region. The document approves the main tasks, functions and means of TFOMS, as well as the procedure for control over their activities and the mechanism for their liquidation.

Organizations, individual entrepreneurs and individuals who are not recognized as individual entrepreneurs are still recognized as policyholders for working citizens ( clause 1 of Art. 11 of Law N 326-FZ ). A separate group includes individual entrepreneurs, private notaries and lawyers. The insured is registered with the territorial bodies of the Pension Fund of the Russian Federation. Features of registration selected categories policyholders and their payment of insurance premiums for compulsory medical insurance from January 1, 2012 are established by the Government of the Russian Federation. Policyholders are payers of compulsory health insurance contributions in accordance with Law N 212-FZ ( Art. 22 of Law N 326-FZ ).

The territorial bodies of the PFR submit information on the payment of insurance premiums for the compulsory health insurance of the working population to the TFOMS in the manner determined by the agreement on information exchange between the PFR and the FFOMS.

The insurers for non-working citizens are the executive authorities of the constituent entity of the Russian Federation ( clause 2 of Art. 11 of Law N 326-FZ ). Now the regional authorities transfer money for them to the MHIF on a leftover basis, as much as they can. This leads to an imbalance in the compulsory medical insurance system and, accordingly, to an inadequacy of the standards of medical care required for Russian citizens.

First Art. 23 and 24 of Law N 326-FZ a phased transition to a fixed payment for the non-working population was established. This payment will be the same for all regions of the Russian Federation due to the fact that it is the same insurance premium as the employer's payments in the CHI system. Article 25 of this Law, liability is established for non-payment of these contributions.

In 2011, payments to the non-working population are rigidly fixed at the 2010 level. Starting from 2012, a single compulsory health insurance tariff for the non-working population will be established for the whole country. The law on establishing payments to the compulsory health insurance system for the non-working population is planned to be adopted in the first half of 2011.

Medical rates will become the same for all insurance medical organizations that pay for medical care provided in one medical organization.

The tariff for the payment of medical care is established by an agreement between the authorized regional body, the TFOMI, representatives of medical and insurance organizations, professional medical associations, trade unions of medical workers ( Art. 30 of Law N 326-FZ ).

The provisions defining the legal status, the peculiarities of the formation and spending of funds of insurance medical organizations have been clarified. Such funds are divided into targeted and own ( Art. 14 of Law N 326-FZ ).

Medical insurance organizations keep separate records of their own funds and compulsory medical insurance funds intended to pay for medical care. Earmarked funds cannot pass into the ownership of an insurance organization ( Art. 28 of Law N 326-FZ ), with the exception of cases stipulated by this Law.

System of contracts


A citizen receives free medical care under compulsory medical insurance on the basis of an agreement concluded in his favor by participants in this form of service.

A medical organization provides compulsory medical insurance services on the basis of an agreement for the provision and payment of medical care, concluded with an insurance organization. A medical organization has no right to refuse to provide medical assistance to insured persons in accordance with the territorial compulsory medical insurance program ( Clause 5 of Art. 15 of Law N 326-FZ ).

An insurance medical organization directs a medical organization earmarked funds to pay for medical care under such contracts ( clause 2 of Art. 28 of Law N 326-FZ ). She receives these funds from TFOMI. The funds are sent to the medical organization initially in advance, the unused earmarked funds must be returned by the medical organization to the insurer, and then to the TFOMI. Liability for misappropriation of funds has been established.

V Chapter 8 of Law N 326-FZ a system of contracts in compulsory medical insurance and a mechanism for organizing control of the volumes, terms, quality and conditions of providing medical care to insured persons have been defined in detail.

In the standard forms of contracts approved by the Ministry of Health and social development RF, these rights and obligations will be specified, and penalties are provided for each violation of the terms of the agreement.

Modernization of healthcare


Since 2011, contributions to the FFOMS will grow by 2%. The money, as you know, will be used to modernize healthcare. Regional modernization programs include increased accessibility outpatient care, within the framework of which the salaries of specialist doctors working in polyclinics should be increased. A similar situation and with doctors in hospitals.

Chapter 11 "Final Provisions" of Law N 326-FZ it was determined: in order to improve the quality and availability of medical care provided to the insured, during 2011-2012, regional programs for the modernization of healthcare of the constituent entities of the Russian Federation and programs for the modernization of federal government agencies providing medical care, the norms, rules are prescribed transition period for 2011-2012.

Of course, a one-step transition "to new rails" is, in principle, impossible. Currently, the MHIF, insurance companies, and medical institutions are studying Law N 326-FZ ... Until financial flows have been debugged, the necessary programs have not been prepared, and an algorithm of actions has not been formed. Everything takes time.

Time will tell whether the working citizen, for whom the FFOMS receives contributions, will become the central figure in healthcare. In the meantime, our health care system is geared more towards retirees rather than working citizens. In other words, the most services are received by those who can spend a lot of time queuing in front of the doctor's office.

And we are all not even interested in how our money comes to the compulsory medical insurance system, how and on what it is spent there, what are the costs of administrative staff, maintenance of buildings, all kinds of trips, participation of doctors in conferences, etc. But this is all inappropriate spending. As consumers of this service, as citizens, we do not know anything about it, but we pay.


Changes in legislation in connection with the adoption of the Law on CHI


Law N 313-FZ changes some legislative acts in particular in RF Tax Code , Federal Laws N 212-FZ, "On the organization of insurance business in the Russian Federation" , " On individual (personified) accounting in the compulsory pension insurance system ", " About the circulation of medicines ", RF Budget Code , RF Code of Administrative Offenses .

Let's briefly consider the main changes affecting the activities of organizations and entrepreneurs.

In the Law N 212-FZ the mention of TFOMS is excluded


Insofar as Law N 326-FZ since 2012, a single insurer has been established - FFOMS, the mention of territorial CHI funds from January 1, 2012 will be excluded from the title and a number of articles Law N 212-FZ ... For example, in Art. 58 and 58.1 of this Law from the text of tables with a breakdown of insurance rates by extrabudgetary funds the reference to TFOMI will be excluded. It was previously established that since 2012 in this fund contributions must be paid at a rate of 0%. Now it has been established that the territories will receive transfers from the FFOMS to finance the powers transferred to the regions in the field of compulsory medical insurance.

V RF Tax Code prescriptions for benefits for insurers and doctors


V Tax Code of the Russian Federation amendments are being made to clarify the list of benefits in relation to the amounts paid in the compulsory health insurance system.

First, according to sub. 7 p. 3 art. 149 of the Tax Code of the Russian Federation not subject to VAT for insurance, coinsurance and reinsurance services provided by insurance companies. Since January 1, 2012, medical insurance organizations - participants in the CHI do not pay VAT when receiving funds from the TFOMI, if these funds:

- are targeted and are listed on the basis of an agreement on the financial support of compulsory medical insurance;

- are intended for conducting a case under compulsory medical insurance;

- are a reward for performing actions, stipulated by the contract on the financial support of the compulsory medical insurance.

The same funds are not taken into account in income when determining the base for income tax (new sub. 14 p. 1 of art. 251 of the Tax Code of the Russian Federation ). Accordingly, from this date sub. 30 p. 1 of Art. 251 of the Tax Code of the Russian Federation loses its force, and therefore in Clause 48.1 of Art. 270 The Code also clarified the list of costs that are not taken into account when calculating income tax.

The expenses will not include funds transferred to medical organizations to pay for medical care to insured persons in accordance with the contract for the provision and payment of medical care.

Article 294.1 of the Tax Code of the Russian Federation , which establishes the specifics of determining the income and expenses of medical insurance organizations, is set out in new edition.

Now the funds received from the TFOMI will be accounted for in income if they are intended for conducting a case under the CHI or are remuneration under an agreement on financial support for the CHI.

Changes in personalized accounting


Law N 313-FZ changes were made to Federal Law of 01.04.1996 N 27-FZ "On individual (personified) accounting in the compulsory pension insurance system" (Further - Law N 27-FZ ). The preamble of the Law is supplemented with the following provision: personalized accounting for this Law also applies to persons eligible for state social assistance, to additional measures state support in accordance with Federal Law of December 29, 2006 N 256-FZ "On additional measures of state support for families with children" ... This record will be kept for the purposes of compulsory medical insurance by the Pension Fund of the Russian Federation. The FIU will be obliged to submit to the FFOMS information about the working insured persons in the system of individual (personified) accounting required for compulsory health insurance. The procedure for such an exchange of information will be established by an agreement between the FIU and FFOMS ( Art. 16 of Law N 326-FZ ).

Clarifications and in paragraph 1 of Art. 8 of Law N 27-FZ .

It is indicated that documents in electronic form containing information about insured persons, sent by the insured to the Pension Fund of the Russian Federation, must be certified electronically digitally signed in accordance with Federal Law of 10.01.2002 N 1-FZ "On Electronic Digital Signature" .

Changes in the situation of insurance companies


In particular, from January 1, 2012, the requirements for minimum size of the authorized capital of an insurer that carries out exclusively medical insurance (changes in clause 3 of Art. 25 of the Law "On the organization of insurance business in the Russian Federation" ).

In accordance with the new edition clause 2 of Art. 18 of Law N 125-FZ the insurer will be obliged to send to the TFOMS information about the decision to pay the costs of treatment of the insured immediately after the serious accident at work, at the expense of compulsory social insurance against accidents at work and occupational diseases. The form and procedure for sending such information must be approved by the insurer in agreement with the FFOMS.

Other innovations


The procedure and conditions for the provision of interbudgetary transfers and subventions from the FFOMS budget to the territorial CHI funds are being adjusted from January 1, 2012 in accordance with Law N 326-FZ (changes made to RF Budget Code ).

V Federal Law of 12.04.2010 N 61-FZ "On the Circulation of Medicines" numerous changes are made.

For example, in Art. 44 of this Law, it is established that an organization that has received permission to conduct a clinical trial of a medicinal product for medical use is obliged to insure the risk of harm to the life and health of the patient by concluding an agreement compulsory insurance... Patient participation in such a study in the absence of a compulsory insurance contract is not allowed. The procedure for exercising the rights and obligations of the parties under the compulsory insurance contract is established by standard rules.

Besides, in Art. 71 of Law N 313-FZ specified:

- requirements for the information provided by the applicants about medical organizations in which clinical trials of a medicinal product for medical use are supposed to be carried out, and the quality of medicinal products;

- requirements for the procedure and conditions of life and health insurance of patients participating in a clinical trial of a medicinal product;

- mechanisms allowing to carry out procedures for examination and registration of medicinal products on the basis of documents submitted for registration before September 1, 2010;

- conditions for the circulation of medicinal products in packaging with markings applied in accordance with the requirements in force before September 1, 2010.


GUARANTOR's comment

See graphic copy of the official publication

Federal Law of November 29, 2010 N 326-fz "On Compulsory Health Insurance in the Russian Federation" (as amended on June 14, November 30, December 3, 2011)

GUARANTOR's comment

Cm. comments to this Federal Law

Chapter 1. General Provisions

Article 1. The subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory health insurance, including determining the legal status of subjects of compulsory health insurance and participants in compulsory health insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and liability associated with the payment of insurance contributions to the non-working population.

GUARANTOR's comment

Cm. comments to Article 1 of this Federal Law

Article 2. Legal basis for compulsory health insurance

1. Legislation on compulsory health insurance is based on Of the Constitution Russian Federation and consists of Fundamentals of legislation Of the Russian Federation on the protection of the health of citizens, Federal law of July 16, 1999 N 165-FZ "On the foundations of compulsory social insurance", this Federal Law, other federal laws, laws of the constituent entities of the Russian Federation. Relations associated with compulsory health insurance are also governed by other regulatory legal acts of the Russian Federation, other regulatory legal acts of the constituent entities of the Russian Federation.

GUARANTOR's comment

Cm. the federal law of November 21, 2011 N 323-FZ "On the basics of health protection of citizens in the Russian Federation"

2. In the event that an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation shall apply.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate explanations may be issued in okay established by the Government of the Russian Federation.

GUARANTOR's comment

Cm. comments to Article 2 of this Federal Law

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1)compulsory health insurance- a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in accordance with this Federal law cases within the framework of the basic compulsory health insurance program;

2)compulsory health insurance object-insurance risk associated with the emergence insured event;

3)insurance risk- the anticipated event, upon the occurrence of which it becomes necessary to incur expenses for the payment of medical care provided to the insured person;

4)insurance case- an event that has occurred (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage for compulsory health insurance;

5)insurance coverage for compulsory health insurance(hereinafter - insurance coverage) - fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization;

6)insurance premiums for compulsory health insurance- compulsory payments, which are paid by the policyholders, have an impersonal nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7)insured person- individual which is covered by compulsory health insurance in accordance with this Federal Law;

8)basic compulsory health insurance program- component the program of state guarantees for the free provision of medical care to citizens, which determines the rights of insured persons to provide them free medical care at the expense of compulsory medical insurance throughout the territory of the Russian Federation and establishes uniform requirements for territorial compulsory medical insurance programs;

9)territorial compulsory health insurance program- an integral part of the territorial program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to provide them with free medical care on the territory of the subject of the Russian Federation and meets the uniform requirements of the basic program of compulsory medical insurance.

This law guarantees free medical care to Russian citizens through the creation of a compulsory health insurance system. Normative document(Federal Law of the Russian Federation 326 on compulsory health insurance) regulates relations between structural units, the procedure for financing and control.

The structure of the social system for providing the population with medical services

The system of compulsory health insurance (CHI), as well as, includes policyholders, insurers and insured persons.

OMC participants:

• citizens;
• organizations and enterprises;
• medical institutions;
• insurance organizations;
• Social Insurance Fund;
• territorial funds.

The role of the insurer is the state represented by the Government of the Russian Federation. It delegates part of its functions to the localities, to the heads of the subjects of the federation. Normative base, including tariffs, determination of the list of services, is established by the Government.

The video simply and clearly tells about compulsory health insurance:

Based State Program territorial conditions are developed and implemented.

The essence of the system is the receipt of the basic package of medical care at the place of residence. Emergency ambulance services are available throughout the territory.

Policyholders - legal entities, individual entrepreneurs who pay insurance premiums to the FSS.

It can be:


• state;
• municipal;
• private enterprises.

Insured persons - working citizens with a compulsory medical insurance policy.

The Social Insurance Fund was created as a non-profit organization and has its own structural units in the form of territorial funds. Its functions include the accumulation of insurance premiums, co-financing of regional programs.

The rights and obligations of the FSS:

• is one of the developers of the state program for guaranteed receipt of free medical care;
• monitors and manages financial assets;
• keeps records of all insured persons;
• determines the number of regional insurance organizations;
• medical institutions providing services;
• checks the competence of territorial funds;
• cooperates with international organizations in the field of compulsory medical insurance.

Territorial funds are representatives of a regional insurer, which is the highest body of local executive power.

Functions of territorial funds:


• collection, accounting and spending of social insurance funds;
• development of regional programs based on the federal one, including per capita standards;
• formation of a register of policyholders;
• insured persons;
• protection of the rights of citizens when receiving low-quality assistance;
• audit of the activities of medical institutions and medical insurance organizations.

Medical insurance organization- an intermediate link between the terfond and medical institutions, between insured persons and a polyclinic (hospital).

She concludes an agreement on the provision of services with each institution and monitors their implementation. Based on the data provided, the regional fund allocates funds for a medical insurance company, which subsequently disposes of them in accordance with the agreed conditions.

To provide outpatient, inpatient, emergency services, you must obtain a state license.

If you ask yourself a question, then to participate in the state CHI program, you need to submit an application to the terfond. Organizations of all types of ownership have the right to be included in the register of medical institutions that provide compulsory medical services.

Legal guarantees and obligations of medical organizations:

• timely and full receipt of funds for the provided insurance services;
• appeal against actions of insurance organizations;
• provision of free medical care in accordance with the compulsory medical insurance, in some cases the patient is provided;
• providing the necessary information to patients about the services provided, the mode of operation;
• keeping records of insured persons;
• informing the territorial fund about the services provided.

In the case of incomplete assistance, poor quality funding is reduced, or the issue of license revocation is resolved.

The video explains the difference between compulsory and voluntary health insurance:

Financing of the state program of compulsory medical insurance in accordance with federal law

Contributions for each insured person to the insurance fund are made by enterprises and organizations registered in the territory of the Russian Federation. Do you need OSAGO, if there is a CASCO, find out.

The amount of contributions is approved in each subject on the basis of an agreement between the executive branch, the territorial fund, the insurance organization and the medical institution. The structure of the tariff (cost items) is determined by the federal executive body.

It includes:

• staff salaries and accruals for it;
• the cost of drugs, tools, consumables;
• nutrition of patients;
• payment for diagnostics in other institutions;
• communal payments;
• social contributions for health workers;
• communication services, Internet;
• software installation and support;
• purchase of equipment up to 100 thousand rubles.

The established rate of reimbursement for the service rendered to the insured person in the clinic (hospital) is constant for all insurance companies in the region. He will tell you about car insurance without life insurance.

On the video Financing of the State MHI Program:

Income part Federal Fund consists:

• from compulsory insurance premiums;
• amounts of fines and penalties;
• outstanding payments;
• subsidies from the federal budget;
• profits from free funds placed in credit or investment organizations... How to add a driver to electronic policy OSAGO learn in.

Expenditure items of the Federal Insurance Fund:

• subventions to territorial funds;
• fulfillment of the obligations of the Government;
• the contents of the apparatus.

The budget of the territorial fund is formed on the basis of:

• additional deductions for compulsory medical insurance from enterprises and organizations;
• regional payments for the provision of services not included in the basic program;
• subsidies from the Social Insurance Fund;
• accrued arrears, fines, penalties.

Territorial funds, when their own funds are insufficient, receive subventions (grants) from the Federal Fund.

Financial support is provided if the following conditions are met:

• fulfillment of the requirement for insurance of the non-working population in the amount specified in the regional budget;
• its compliance with the indicator calculated according to the federal standard;
• monthly transfer 1/12 of the approved annual amount in the FSS.

Territorial funds' expenditures are mainly related to the implementation of regional compulsory health insurance programs.

As part of the Federal and territorial funds, a standardized reserve is created, which is necessary for stable financing, the size and procedure for using which are determined by the highest federal and regional authorities. Read about the compulsory medical insurance policy from Rosgosstrakh.

Basic program of compulsory health insurance of citizens in accordance with the Federal Law of the Russian Federation 326

The federal standard laid down in the compulsory medical insurance is adjusted at the level of the constituent entities of the federation, based on local conditions: age categories, health status of the population and infrastructure. Learn about life and health insurance for a child athlete at.

Territorial programs must ensure a decrease in mortality from diseases, an improvement in the quality of medical services.

Insured citizens who have applied for are entitled to receive all types of assistance free of charge: from emergency to preventive, using modern diagnostic equipment and instruments.

The video shows the basic compulsory health insurance program:

Federal Law 326-FZ, adopted in 2010, is the basis for the functioning of the compulsory health insurance system. The purpose of the document is to establish legal relationship between the participants, the definition of the basic Program, sources of funding and responsibilities of the parties, which is mandatory for.

Article 1.

Introduce into the Code of the Russian Federation on Administrative Offenses (Collected Legislation of the Russian Federation, 2002, No. 1, Art. 1; N 30, Art. 3029; N 44, Art. 4295, 4298; 2003, N 27, Art. 2700, 2708, 2717; N 46, Art. 4434; N 50, Art. 4847, 4855; 2004, N 31, Art. 3229; N 34, Art. 3529, 3533; N 44, Art. 4266; 2005, N 1, Art. 9, 13, 40, 45; N 10, Art. 763; N 13, Art. 1075, 1077; N 19, Art. 1752; N 27, Art. 2719, 2721; N 30, Art. 3104, 3131; N 50, Art.5247; N 52, Art.5574; 2006, N 1, Art. 4, 10; N 2, Art. 172, 175; N 6, Art. 636; N 10, Art. 1067; N 12, Art. 1234; N 17, Art. 1776; N 18, Art. 1907; N 19, Art. 2066; N 23, Art. 2380; N 31, Art. 3420, 3438, 3452; N 45, Art. 4641; No. 50, Art. 5279, 5281; No. 52, Art. 5498; 2007, No. 1, Art. 21, 25, 29; No. 7, Art. 840; No. 16, Art. 1825; No. 17, Art. 1930; No. 26, art. 3089; No. 30, art. 3755; No. 31, art. 4007, 4008; No. 41, art. 4845; No. 43, art. 5084; No. 46, art. 5553; 2008, No. 18, art. 1941; N 20, Art. 2251, 2259; N 29, Art. 3418; N 30, Art. 3582, 3604; N 49, Art. 5745; N 52, Art. 6235, 6236; 200 9, No. 1, Art. 17; N 7, art. 771, 777; 23, Art. 2759, 2767; No. 26, Art. 3120, 3122, 3131; 29, Art. 3597, 3642; No. 30, Art. 3739; 48, Art. 5711,5724; No. 52, art. 6412; 2010, N 1, Art. 1; 18, Art. 2145; 19, Art. 2291; No. 21, Art. 2525; 23, Art. 2790; No. 27, Art. 3416; No. 30, Art. 4002, 4006, 4007; 31, Art. 4158, 4164, 4191, 4193, 4195, 4206, 4207, 4208; 41, Art. 5192; 49, Art. 6409; 2011, N 1, Art. 10, 23, 29, 54; N 7, art. 901; 15, Art. 2039; N 17, art. 2310; 19, Art. 2714, 2715; 23, Art. 3260, 3267; No. 27, Art. 3873; 29, Art. 4290, 4291, 4298; No. 30, Art. 4573, 4585, 4590, 4598, 4600, 4601, 4605; 46, Art. 6406; 47, Art. 6602; 48, Art. 6728, 6730; 49, Art. 7025, 7061; N 50, Art. 7342, 7345, 7346, 7351, 7352, 7355, 7362, 7366; 2012, N 6, Art. 621; N 10, art. 1166; 19, Art. 2278, 2281; No. 24, Art. 3068, 3069, 3082; 29, Art. 3996; 31, Art. 4320, 4322, 4330; 41, Art. 5523; 47, Art. 6402, 6403, 6404, 6405; 49, Art. 6752, 6757; 53, Art. 7577, 7602, 7640, 7641; 2013, N 8, Art. 717, 720; 14, Art. 1651, 1657, 1658, 1666; 19, Art. 2307, 2323, 2325; No. 26, Art. 3207, 3208, 3209; No. 27, Art. 3454, 3469, 3470, 3477, 3478; No. 30, Art. 4025, 4029, 4030, 4031, 4032, 4034, 4036, 4040, 4044, 4078, 4082; 31, Art. 4191; 43, Art. 5443, 5444, 5445, 5452; 44, Art. 5624, 5643; 48, Art. 6159, 6161, 6163, 6165; 49, Art. 6327, 6341, 6343; 51, Art. 6683, 6685, 6695, 6696; No. 52, art. 6961, 6980, 6986, 6994, 6995, 7002; 2014, N 6, Art. 557, 559, 566; 11, Art. 1092, 1096; 14, Art. 1561,1562; 19, Art. 2302, 2306, 2310, 2317, 2324, 2325, 2326, 2327, 2330, 2335; No. 26, Art. 3366, 3379, 3395; No. 30, Art. 4211, 4214, 4218, 4228, 4233, 4244, 4248, 4256, 4259, 4264, 4278; N 42, Art. 5615; 43, Art. 5799; 48, Art. 6636, 6638, 6642, 6643, 6651; No. 52, art. 7541, 7545, 7547, 7548, 7550, 7557; 2015, N 1, Art. 29, 35, 67, 74, 83, 85; No. 6, Art. 885; N 10, art. 1405, 1416; 13, Art. 1811; 18, Art. 2614, 2620; No. 21, Art. 2981; No. 24, Art. 3370; No. 27, Art. 3945, 3950; 29, Art. 4354, 4356, 4359, 4374, 4376, 4391; 41, Art. 5629, 5637; 44, Art. 6046; N 45, Art. 6205, 6208; 48, Art. 6706, 6710, 6711, 6716; 51, Art. 7249, 7250; 2016, N 1, Art. 11, 28, 59, 63, 84; N 10, art. 1323; 11, Art. 1481, 1490, 1491, 1493; 14, Art. 1907; 15, Art. 2051; 18, Art. 2514; 23, Art. 3284, 3285) the following changes:

1) paragraph one of part 1 of Article 3.5 after the words "fifteen thousand rubles, in the cases provided for by" add the words "article 5.35 1," after the words "twenty thousand rubles," add the words "in the cases provided for by article 6.1 1 of this Code, - thirty thousand rubles, ";

2) part 1 of Article 4.5 after the words "for violation of the budgetary legislation of the Russian Federation and other normative legal acts governing budgetary legal relations," add the words "as well as for the administrative offenses provided for by Articles 5.35 1, 6.1 1 of this Code, for violation";

3) supplement with article 5.35 1 as follows:

"Article 5.35 1. Non-payment of funds for the maintenance of children or disabled parents

1. Failure by a parent to pay, without good reason, in violation of a court decision or a notarized agreement of funds for the maintenance of minor children or disabled children who have reached the age of eighteen, within two or more months from the date of initiation of enforcement proceedings, if such actions do not contain a criminal offense, -

entails compulsory work for up to one hundred and fifty hours or administrative arrest for a period of ten to fifteen days or imposition administrative fine for persons in respect of whom, in accordance with this Code, compulsory work or administrative arrest cannot be applied, in the amount of twenty thousand rubles.

2. Failure to pay by adult able-bodied children without good reason in violation of a court decision or a notarized agreement of funds for the maintenance of disabled parents within two or more months from the date of initiation of enforcement proceedings, if such actions do not contain a criminal offense, -

entails compulsory work for a period of up to one hundred and fifty hours or an administrative arrest for a period of ten to fifteen days or the imposition of an administrative fine on persons in respect of whom, in accordance with this Code, compulsory work or administrative arrest cannot be applied, in the amount of twenty thousand rubles. " ;

4) supplement with article 6.1 1 as follows:

"Article 6.1 1. Beating

Beating or committing other violent actions that caused physical pain, but did not entail the consequences specified in Article 115 of the Criminal Code of the Russian Federation, if these actions do not contain a criminal offense, -

shall entail the imposition of an administrative fine in the amount of five thousand to thirty thousand rubles, or an administrative arrest for a period of ten to fifteen days, or compulsory work for a period of sixty to one hundred and twenty hours. ";

5) Article 7.27 shall be stated in the following edition:

"Article 7.27. Petty theft

1. Petty theft of someone else's property, the value of which does not exceed one thousand rubles, by theft, fraud, misappropriation or embezzlement in the absence of signs of crimes provided for in parts two, three and four of Article 158, Article 158 1, parts two, three and four of Article 159 , parts two, three and four of Article 159 1, parts two, three and four of Article 159 2, parts two, three and four of Article 159 3, parts two, three and four of Article 159 5, parts two, third and fourth of Article 159 6 and parts two and three of Article 160 of the Criminal Code of the Russian Federation, -

shall entail the imposition of an administrative fine in the amount of up to five times the value of the stolen property, but not less than one thousand rubles, or an administrative arrest for a period of up to fifteen days, or compulsory work for a period of up to fifty hours.

2. Petty theft of someone else's property worth more than one thousand rubles, but not more than two thousand five hundred rubles by theft, fraud, misappropriation or embezzlement in the absence of signs of crimes provided for in parts two, three and four of Article 158, Article 158 1, parts two, three and the fourth part of Article 159, parts two, three and four of Article 159 1, parts two, three and four of Article 159 2, parts two, three and four of Article 159 3, parts two, three and four of Article 159 5, parts two, three and fourth article 159 6 and parts two and three of article 160 of the Criminal Code of the Russian Federation, -

shall entail the imposition of an administrative fine in the amount of up to five times the value of the stolen property, but not less than three thousand rubles, or administrative arrest for a period of ten to fifteen days, or compulsory work for a period of up to one hundred and twenty hours. ";

6) in part 1 of Article 23.1 the numbers "5.37 - 5.43" shall be replaced by the numbers "5.35 1, 5.37 - 5.43", the numbers "6.1, 6.2" shall be replaced by the numbers "6.1 - 6.2";

7) in part 2 of article 28.3:

a) paragraph 1 after the figures "5.69," add the figures "6.1 1,";

b) in paragraph 77 the figures "17.3 - 17.6" shall be replaced by the figures "5.35 1, 17.3 - 17.6";

8) part 1 of article 28.7 after the words "actions requiring significant time expenditures," add the words "and also in cases of committing administrative offenses provided by Articles 6.1 1, 7.27 of this Code, ".

Article 2.

Introduce into the Federal Law of October 2, 2007 N 229-FZ "On Enforcement Proceedings" (Collected Legislation of the Russian Federation, 2007, N 41, Art. 4849; 2008, N 20, Art. 2251; 2009, N 1, Art. 14 ; N 23, Art. 2761; N 29, Art. 3642; N 39, Art. 4539, 4540; N 51, Art. 6162; 2010, N 31, Art. 4182; 2011, N 7, Art. 905; N 17, Art.2312; N 27, Art. 3873; N 29, Art. 4287; N 30, Art. 4573, 4574; N 48, Art. 6728; N 49, Art. 7014, 7041, 7061, 7067; N 50, Art. 7343, 7347, 7352, 7357; 2012, No. 31, Art. 4322, 4333; 2013, No. 14, Art. 1641, 1657; No. 30, Art. 4039; No. 51, Art. 6678, 6699; No. 52, Art. 6948, 7006; 2014, No. 11, Art. 1099; No. 19, Art. 2331; No. 30, Art. 4217; No. 42, Art. 5615;

43, Art. 5799; No. 52, art. 7543; 2015, N 1, Art. 29; N 10, art. 1393, 1410, 1411, 1427; 14, Art. 2022; No. 27, Art. 3945, 3977, 4001; 48, Art. 6706; 2016, N 1, Art. 11, 13, 45, 64; 11, Art. 1493; 14, Art. 1910; 18, Art. 2511) the following changes:

1) the title of Chapter 12 shall be stated as follows:

"Chapter 12. Recovery of a fine imposed as a punishment for committing a crime. Procedure for the execution of an executive document on confiscation of property and an executive document on payment judicial fine designated as a measure of a criminal-legal nature ";

2) supplement with Article 103 1 as follows:

"Article 103 1. Execution of a court fine imposed as a measure of a criminal law nature

1. A court fine imposed as a criminal law measure in accordance with Article 104 4 of the Criminal Code of the Russian Federation (hereinafter referred to as the court fine) shall be executed according to the rules established by this Federal Law, with the specifics established by this article.

2. The court fine shall be executed by the person to whom this measure has been imposed, within the time period specified by the court in the ruling, ruling on the appointment of a measure of a criminal-legal nature.

3. Control over the execution of the court fine by the person to whom this measure has been imposed shall be assigned to the bailiff.

4. The decision to initiate enforcement proceedings or to refuse to initiate it shall be issued by the bailiff-executor no later than three days from the date of receipt of the writ of execution by the bailiffs unit. The decision to refuse to initiate enforcement proceedings is approved by the senior bailiff or his deputy and sent to the court on the day it is issued.

5. When initiating enforcement proceedings, the term for the voluntary execution of the court fine is not established by the bailiff, the enforcement fee is not collected.

6. If after ten calendar days from the date of expiration of the term for payment of the court fine, the bailiff-executor has no information on the payment by the debtor of the relevant sums of money, he submits to the court a submission to abolish the said measure of a criminal-legal nature and to resolve the issue of bringing a person to criminal liability.

7. Enforcement proceedings on writ of execution on the payment of a court fine ends in the event of:

1) payment of the court fine in full;

2) the return of the executive document at the request of the court that issued the executive document;

3) referrals to the court that issued the executive order, submissions to cancel the court fine. ".

President of Russian Federation