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what is a compulsory medical insurance policy?

Compulsory medical insurance: how to get it, what can be treated, how it differs from VHI, is it possible to treat teeth for free

The compulsory medical insurance policy is a policy of compulsory free medical insurance that the state provides you. With it, you have access to all local doctors, high-tech treatment, special types of treatment under regional programs and even preferential medicines. Below we analyze: what compulsory medical insurance is, how it all works, where to get it, what can be treated and what kind of help you can count on if compulsory medical insurance policies are not available to you or you have not yet reissued your health insurance policy.

Compulsory medical insurance policy – what is it

History and economics of policies

A small historical fact: free medicine with a centralized distribution of money is evil. If all people in the country receive medical care free of charge and at the same time the money goes to hospitals according to the “plan from above” – there is an imbalance in which some hospitals receive more money and develop, while others receive very little funding and cease to provide adequate care. In Soviet times, everything looked something like this, so people with diseases had to travel from small towns to large ones (sometimes to another region) in order to receive adequate treatment.

The solution to the problem: the hospital should receive money for the services it provides. But this leads to a new problem: only those who have money receive medical care (now this problem is acute in the United States). Russia went the other way: the country introduced compulsory health insurance, according to which any resident of the country can receive free medical care if he has an insurance policy – and policies are distributed to all citizens. At the same time, the hospital still receives money for providing its services – this money is paid to it by the Compulsory Health Insurance Fund (CHI), with which large insurance companies cooperate. And insurance, in turn, receive money from the state, more precisely, from the fees paid by employers for employees.

Legal side

Since compulsory medical insurance is a federal program, it is spelled out in the federal law “On Compulsory Medical Insurance”. But that’s not all – there are also regional programs that can expand the federal program. Below we will provide a list of medical services that can be obtained using paper or electronic policies under the basic program, but if the procedure you need is not among the mandatory medical ones, look for it in regional regulations, usually they can be found on the website of the regional administration. For example: a decree of the Moscow government on the provision of preferential medicines to the population.

Types of policies

Policies are paper, electronic and on cards. What does a paper policy look like:

What does the policy look like on the card:

The state is trying to withdraw paper policies from circulation and replace them with electronic ones, because it is more convenient. But until the end of 2025, there is a transition period: not all hospitals have switched to electronic document management, so they may be asked to provide a paper version. Now the easiest way to issue a policy is via the Internet, so you should do this:

1. Issue an electronic policy.

2. Order a card.

3. Print the statement.

The main thing in the statement is the barcode, which is located above the “Information about the insured person” block. Using this code, the hospital will be able to submit data to the insurance company and, as a result, provide you with a range of free medical services for compulsory medical insurance.

How compulsory medical insurance policies are changing in 2023 – a new type of compulsory medical insurance policy

In 2023, the policy card underwent a slight redesign, the illustration above is just the result of this redesign. This did not affect the volume of services in any way, the mandatory replacement of the policy was not introduced – therefore, the redesign actually did not affect anything. But in 2022-2023, there were more interesting changes:

1. From the fall of 2022, you can ask for help without a policy at all. A unified state database of compulsory medical insurance policies has been launched – now all your data is stored in a database to which the hospital has access. All you need to get help is to issue a policy in electronic form (so that the data is entered into the database) and go to the hospital with a passport. Your policy will be found according to your passport data.

2. From 2023, newborns are issued policies automatically. Previously, the mother’s compulsory medical insurance policy applied to the newborn, this kind of temporary policy was valid for 30 days, after which it was necessary to issue a separate permanent one. Now the procedure for issuing digital policies to newborns has been made automatic – you need to use the State Services portal to get a number, and that’s it.

There are no plans for any global changes in policies, medical and electronic services in 2023.

Who has the right to receive a compulsory medical insurance policy

Any citizen of the Russian Federation can get a permanent policy free of charge and immediately under the compulsory medical insurance program, insurance is indefinite. The situation with foreigners is a little more complicated: if a foreigner has a legal reason to live in the Russian Federation (residence permit, work visa, refugee status), then he can get a fixed-term policy – this policy will be valid either until the end of the year or until the end of the legal stay (whichever comes earlier will be the date). If the policy has ended, it is necessary to issue a new one if there are legal reasons for staying.

What treatment can be obtained without a policy

Even if you do not have a policy or you are not a citizen of Russia, there are a number of medical services that you can get for free. This is:

  • First aid, stabilization.
  • Help with childbirth.
  • Treatment of newborns.

But it should be noted that assistance with childbirth is also the first emergency aid, so there are no problems with it, but problems may arise with the treatment of newborns if the disease / condition arose some time after birth. If there are no other options, you can try to use such help, but it is better to apply for VHI or contact a paid clinic.

Treatment under compulsory medical insurance – what is free and what is not

According to federal law, policyholders have the right to urgent medical care (including transportation, but not by helicopter) and prevention, diagnosis, treatment of a number of diseases in the following categories:

Category/SystemExamples of diseases
Infections, including parasiticAmoebiasis, hymenolepiasis, clonorchiasis, giardiasis, malaria, toxocariasis, toxoplasmosis, trichinosis, enterobiosis (and in general everything that ends in -oz and -ez)
NeoplasmsBenign, malignant, cysts
Endocrine systemDiabetes mellitus, short stature, Addison’s and Cushing’s diseases, acromegaly, hypo- and hyperparathyroidism, hypo- and hyperthyroidism
Metabolism, eating disordersObesity, gout, disorders of fat metabolism or the entire metabolism, hypovitaminosis, lactose intolerance
Nervous systemInsomnia, stroke, encephalopathies, intracranial aneurysms, various genetic diseases
Blood and hematopoietic organsAnemia, membranopathy, hemoglobinopathies, leukemia
Immune systemImmunodeficiencies, sarcoidosis
EyesChalazion, blepharitis, xanthelasma of the eyelid, dacryoadenitis, epiphora, inflammation of the orbit, foreign body in the eye, lesions of the lacrimal apparatus, conjunctivitis, scleritis, corneal ulcer, corneal opacities, keratoconus, cataracts, inflammation and dystrophy, retinal detachment, glaucoma, astigmatism, diplopia, blindness
EarsDiseases of the outer ear, diseases of the middle ear and mastoid process (including otitis), perforation of the tympanic membrane, vestibular disorders, deafness
Blood circulationAtherosclerosis, ischemic heart disease, hypo- and hypertension, fainting, VSD, heart defects, arrhythmia, heart attack
RespiratoryBronchitis, pneumonia, asthma, COPD, various acute respiratory infections, covid
Digestive organsEsophagitis, gastritis, hepatitis, pancreatitis, cholecystitis, enteritis, colitis, proctitis
Genitourinary systemBladder atony, leukoplakia, neoplasms and cysts, urolithiasis, cystalgia, cystitis, diverticulum
Skin and subcutaneous layerVarious dermatitis, psoriasis, arthropathies, urticaria, eczema
Bones, muscles, connective tissueCoxarthrosis, polyarthrosis, gout, arthritis, arthropathies, ankylosing spondylitis
Effects of external factorsVarious injuries and poisoning
MalformationsAnencephaly, heart defects, lack of limbs, cleft lip
Chromosomal abnormalitiesKaryotypes, mosaicisms, Down syndrome

Assistance with pregnancy, childbirth and abortion is separately prescribed, plus the woman in labor receives care in the postpartum period, and newborns receive treatment for many conditions that occur in the period immediately after childbirth.

Note that the above list of diseases is incomplete, we have given it as an example. In practice, compulsory insurance funds and hospitals primarily focus on how difficult it is to provide a medical service. If you need to attract very rare specialists and expensive equipment that is not available in the region to receive free assistance, it will be difficult to get treatment.

Is it possible to undergo free examinations under compulsory medical insurance if you are not sick with anything?

Can. Above, we noted that medical care is provided both for the treatment and prevention of diseases. Diagnosis of diseases at an early stage and preventive examinations are generally called medical examinations, and it is among the free services, although it is usually regulated by local legislation. Specific rules for free medical examination can be found on the website of the territorial division of compulsory medical insurance, but in general the rules are as follows:

  • Persons under 40 years of age are examined every three years.
  • For persons 40 years of age or older, medical examination is carried out annually.

Often, people who have had covid are offered an in-depth medical examination after an illness. But there is an obstacle – you can quickly get an examination only if you called a doctor during your illness and this doctor made a smear, that is, reliably confirmed the presence of the disease (test results after the illness are not taken into account). You can get an in-depth examination after covid even if you did not take a smear during your illness, but you will need to write an application addressed to the director of the hospital and wait for approval. The application is written in free form, you need to specify your data (including the number of compulsory medical insurance) and any confirmation that you have been ill.

Medicines under compulsory medical insurance – what and when you can get for free

Preferential distribution of medicines under compulsory medical insurance is regulated by local legislation. Usually, medicines are given to beneficiaries and people with complex diseases. You can either be given a medicine completely free of charge, or sell it at a 50% discount. Almost all preferential medicines that can be issued should be included in the list of vital medicines. Check the list of diseases in the hospital or on the website of the local administration. For example, all information on preferential medicines for Muscovites is collected here, if you click on “diseases or conditions” in the first block, a drop-down list will open in which these diseases are listed.

How to get a compulsory medical insurance policy

There are a lot of options: you can apply for a policy both live and online. First, we will tell you how to apply for a policy live, then we will show you how to order it online.

If you want to issue a paper policy in person, this can be done at the MFC or a branch of the insurance company, where paper media are issued. Have you chosen an MFC? Just come to the center with a passport and SNILS number, you will be given an application that you will need to fill out and sign. Do you want to contact an insurance company? First you need to choose an insurance company from the list of possible ones:

  • Ingosstrakh;
  • MS Capital;
  • MAKS-M;
  • Medstrakh;
  • INKO-Med;
  • RESO-Med;
  • SOGAZ-Med.

Look for the nearest office, come with your passport and SNILS. Compulsory insurance programs are the same for all insurance companies, the difference is only in the quality of service at the clinic and hospital that cooperate with the insurance company. Previously, it was necessary to tinker with a temporary certificate (permanent ones were issued in a month), now during the day (and sometimes immediately) they issue a certificate or a single card with a policy number on it. By the way, to reissue a policy from another insurance company, you need to go through the same procedure.

How to get a compulsory medical insurance policy online

To get a policy online, you need to fill out this form.

There is nothing complicated in the form itself – you need to specify the SNILS, the region, the form of the policy and the insurance company.

Lost compulsory medical insurance policy – replacement or restoration

If you have lost your policy, just go through the procedure described above. If for some reason you want the old policy, contact the insurance company in which the policy was issued, they will give a duplicate. But there is no difference between the old and the new policy, so it is easier to issue a new one through the State Services or the MFC.

Checking the validity of the compulsory medical insurance policy

You can check the validity of the policy on any regional website of the compulsory medical insurance fund, for example, here.

You need to select the type of policy, then specify the series and number (for old paper policies) or just the number (for new policies on the card). The site will give out all the information on the policy.

Assertion of one’s rights in the provision of compulsory medical insurance services

You may encounter the fact that the doctor refuses to help you with compulsory medical insurance, referring to something: the disease is not included in the list, there is no equipment, Mercury retrograde in the constellation Taurus or something else. In this case, you will have to defend your rights yourself.

First of all, you need to ask the doctor to record a written reasoned refusal to provide the service – so you will have documents in your hands with which you can work. If the doctor refuses to write a refusal, contact the head physician. Then you need to call the insurance company in which you are served. If you do not know which insurance company your policy is registered with, use the policy authentication service above. The insurance number can be found in a search engine or through the website of the regional compulsory medical insurance fund – in Moscow, for example, all information about contact information is collected on this page. Explain the situation and act on the instructions of the insurance agent. Sometimes it happens that the doctor really cannot provide treatment – in this case, they will explain your rights to you and try to find a way out of the situation. If the refusal is illegal, they will tell you how to protect your rights.

Why do you need VHI – differences from compulsory medical insurance

The first difference is that VHI (voluntary health insurance) usually covers what compulsory medical insurance does not cover. Most often we are talking about “optional” dentistry, surgery, rare diseases with expensive treatment and emergency transportation of patients (including by medical helicopter). The second difference is convenience. Usually, VHI implies treatment in paid hospitals, in which there are better wards and smaller queues (or no queues at all).

CHILCA
Who can be an insurerA company from the allowed listAny insurance
Insured eventsSame for everyoneYou can choose what to insure yourself against
Need to pay out of pocket?NoYes
Where does insurance work?Throughout RussiaIt is spelled out in the contract – the policy can also protect against insured events that have arisen while in another country
Which hospitals can be put in?In 99% of cases – statePrivate, occasionally paid chambers in state
How quickly do they provide assistance?If there is a long queue, you will waitAs fast as they can

FAQ

The insurance company’s license has been revoked – what to do?

The chances that the insurance company in which you are serviced under compulsory medical insurance will revoke the license is approximately 0 – only the largest companies on the market are allowed to service these policies. But even if this happens, you just get a new free policy from another insurance company, and that’s it.

I received a compulsory medical insurance policy in one city, and then moved to another

You need to go through the procedure for obtaining compulsory medical insurance again, since your place of residence is indicated in the policy, and the list of hospitals in which you can be put if necessary depends on it.

Do I need to change the compulsory medical insurance when changing the surname?

Yes. It is necessary to change the policy when changing the name or passport data, this must be done within 30 days (although there are no penalties for delay). If you do not change the policy, they may refuse service.

How to apply for compulsory medical insurance for a newborn?

From 2023, it is issued automatically at birth – you do not need to do anything.

Is it possible to treat teeth under compulsory medical insurance?

Yes, although not all diseases are treated. The specific list depends on the dentistry you are applying to, for example, a list of diseases included and not included in the compulsory medical insurance at MEDIUS S dentistry.

Is it possible to get psychological help under compulsory medical insurance?

Yes. Despite the fact that psychological assistance is not directly spelled out in the legislation on compulsory medical insurance, the clinic is unlikely to refuse you. Call the insurance company and find out where you can get free psychological help at your place of residence.

Is covid treatment included in the compulsory medical insurance?

Yes, it includes both treatment and in-depth medical examination after you have been ill. We gave the details of the medical examination above, in short, it can be obtained either if you were diagnosed with covid with a smear during your illness, or if you write an application addressed to the head of the hospital.

Inference

  • Compulsory medical insurance is compulsory free health insurance that you receive from the state.
  • Under compulsory medical insurance, it is possible to treat all diseases for the treatment of which high-tech equipment is not required, and many diseases for which this equipment is required.
  • For compulsory medical insurance, you can also contact psychologists and dentists.
  • Regional extensions of compulsory medical insurance may allow you to receive preferential medicines from the list of vital ones.
  • Compulsory medical insurance can be issued at the MFC, insurance company or through the State Services.
  • If your rights under compulsory medical insurance are not respected, feel free to call the insurance company in which the policy was issued, and figure it out. You pay money for compulsory medical insurance from your taxes and fees, so you have every right to medical care.

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