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what is the compulsory medical insurance system

Compulsory medical insurance (CHI) is one of the types of state compulsory social insurance of citizens in the Russian Federation.

Compulsory medical insurance provides the constitutional right (Article 41 of the Constitution of the Russian Federation) of every citizen of the Russian Federation to receive free medical care (in the event of an insured event) in the proper volume, quality and on time.

Medical care in the compulsory medical insurance system is provided at the expense of compulsory medical insurance under the conditions established by the territorial or basic compulsory medical insurance programs.

Basic program of compulsory medical insurance

The basic program of compulsory medical insurance is an integral part of the Program of State Guarantees of Free Provision of Medical Care to Citizens, approved annually by the Government of the Russian Federation. It contains the types and conditions for the provision of medical care, a list of diseases and conditions that can be treated free of charge under the compulsory medical insurance policy throughout Russia, the procedure and conditions for the provision of medical care (including the procedure for providing citizens with medicines, medical devices, donor blood and its components, medical nutrition for medical reasons), a list of medical organizations providing compulsory medical insurance services and setting deadlines for waiting for medical care.

Territorial program of compulsory medical insurance

The territorial program of compulsory medical insurance is developed on the basis of the Basic program of compulsory medical insurance, but at the expense of additional funding at the level of a specific subject of the Russian Federation in which a citizen lives, it provides for the opportunity to receive free medical care in a more in-depth and expanded format.

Note!

The compulsory medical insurance policy is issued at the place of actual residence. When changing your place of residence and moving to another region, you must attach to an insurance medical organization operating in this territory.

Principles of the compulsory medical insurance system

The main principles of compulsory health insurance are:

  • ensuring, at the expense of compulsory medical insurance, guarantees of free medical care to the insured person in the event of an insured event within the framework of the territorial and basic compulsory medical insurance programs.
  • stability of the financial system of compulsory medical insurance, provided on the basis of equivalence of insurance coverage to compulsory medical insurance funds.
  • the obligation of policyholders to pay insurance premiums for compulsory medical insurance in the amounts established by federal laws, the state guarantee of compliance with the rights of insured persons to fulfill obligations under compulsory medical insurance within the framework of the basic compulsory medical insurance program, regardless of the financial situation of the insurer.
  • creation of conditions for ensuring the availability and quality of medical care provided within the framework of compulsory medical insurance programs.
  • parity of representation of compulsory medical insurance subjects and compulsory medical insurance participants in the management bodies of compulsory medical insurance.

The subjects of compulsory health insurance are:

  • insured persons.
  • policyholders.
  • Federal Compulsory Medical Insurance Fund.

Participants of compulsory medical insurance in the Russian Federation are:

  • territorial compulsory medical insurance funds.
  • medical insurance organizations.
  • medical organizations.

Note:

The volume of free medical care, which is provided under the compulsory medical insurance policy in different regions, may be greater than provided for by the basic program. But under no circumstances can it be less than what is indicated in it.

Medical care under the compulsory medical insurance policy is provided in medical organizations included in the register of the Territorial Compulsory Medical Insurance Fund. Find out more about the territorial program of compulsory medical insurance in your region on the website of your Territorial Compulsory Medical Insurance Fund (TFOMS) and in the section regional regulations. In the Information about medical organizations section, you can find out which medical organizations in your region you can apply for free medical care under the compulsory medical insurance program.

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