In this article, we will discuss getting a compulsory health insurance policy for a person who either does not work at all or works informally. In addition, we will consider how realistic the introduction of a bill that will deprive the unemployed of the OMS policy. But first, we will explain what a CHI policy is.
The OMS policy is a kind of paper, a certificate that guarantees you the receipt of absolutely free medical services in organizations that are accredited by the Russian Federation. In general, every citizen of the Russian Federation must have a compulsory medical insurance policy. As a rule, this document is issued through the company in which this citizen works. University students, pensioners and those who are not officially employed receive the OMS policy themselves. Let's now consider an algorithm of actions that will allow the unemployed to receive an OMS policy.
To get a policy Compulsory health insurance for the unemployed, you need to take a passport, SPS (pension insurance certificate) and a birth certificate. As you know, the legislation of the Russian Federation allows you to independently choose the insurance organization which suits you best. Do not be lazy, read the information on the Internet and study the compulsory health insurance market. This will help you choose the right insurance company. It's easy to do: you go to the official website of the compulsory medical insurance fund, go to the menu "Territorial CHI funds" and click on the contour of the Russian Federation. Then you find your area on the map and click on it. If you did everything correctly, then all the addresses and phone numbers of the organizations necessary to obtain the OMS policy should be displayed on your screen. We dial the indicated phone number of the insurance company and ask the operator when we can come to draw up an OMS policy. Come at the appointed time, taking with you an identity document and SPS. If you are taking out a policy for a child who has not yet turned fourteen, then also bring a birth certificate. You fill out the official paper, which is provided to you by an employee of the insurance organization. After you complete required document, an employee of the organization must issue you a so-called temporary certificate of compulsory health insurance. This certificate will be valid until you are issued an OMS policy. That is, according to this certificate, you will be able to receive qualified medical care, if necessary. By the way, you have a choice of two options for the OMS policy - classic paper or plastic. The carrier depends on your desire. Somewhere in three weeks or four weeks, you can call the insurance company - your policy will most likely have already been made. In theory, the insurance company should notify you that you need to withdraw the policy, by e-mail or by phone, but this does not always happen. Here, in fact, is the algorithm of actions for those who are unemployed and want to get an OMS policy.
Now let's move from the present to the future and try to answer the question, will the unemployed be deprived of mandatory health insurance policies? Indeed, it is not the first year that State Duma deputies have been proposing such a bill that would take away the possibility of free medicine from those who do not work or work, but not officially. Such an innovation is proposed by the party of United Russia, namely by Ildar Gilmutdinov, who submitted these changes to the MLA for general discussion. But the Ministry of Health Russian Federation answered that if such a bill is adopted, it will strictly contradict the Constitutional article number 41, which states that every citizen of the Russian Federation can count on free medical care from the state. Yes, almost every citizen of the Russian Federation now has an OMS medical policy, but not many can clearly answer for what purpose the insurance companies that issue these policies to the population work. And we will answer that insurance organizations that have the right to issue OMS policies also have the option, which implies the protection of the rights of customers, as well as assistance in choosing the necessary medical organization and specialists. If you read the laws on compulsory health insurance, you will find that the sphere of influence of insurance organizations is quite large. This includes the transfer of a client from one medical organization to another, and defending the interests of the patient in case of violation of his rights by medical institutions, and supporting the holding of medical consultations, and much more. All these functions are undoubtedly important for those who have an OMS policy. But not everyone will be able to give their hard-earned money for these seemingly mandatory options.
But you must admit that in order to deprive the unemployed of the right to free healthcare, you must first determine who exactly fits this definition. After all, students and pensioners are also unemployed, but it would be wrong, to put it mildly, to withdraw OMS policies from them. Supporters of the aforementioned innovation want to remove from the Federal Law "on compulsory health insurance" a clause stating that the insured person may be officially unemployed. The exception is the employees of the Russian army. Now we will consider who, in the opinion of the deputies, should remain insured unemployed.
People who care about health are interested in the question of how to get a medical policy for an unemployed person and a newborn, because compulsory medical insurance provides ample opportunities. In the article I will talk about this in detail.
Get medical insurance a citizen of the Russian Federation can at the place of residence, registration does not play a role.
Recently, new policies have become available to Russians that provide medical care in all parts of the country, regardless of registration. You can count on help from a public or private institution. The main thing is that it participates in the program.
Previously, employers provided employees with medical policies. Now every citizen of Russia has the right to choose. He can choose an insurer, a medical institution, and a doctor.
If you do not like the service, you can change the insurer and clinic once a year. Citizens of Russia, foreigners living in the country, and refugees can receive compulsory medical insurance.
Remember, a Russian, regardless of employment, can pay for health insurance that does not have an expiration date. A similar document is available for other categories of people to receive.
In the country, medical care is provided under the compulsory medical insurance program, and every person who goes to the hospital must have a policy with him.
According to the law, the employer is responsible for issuing health insurance, but not everyone is employed. We are talking not only about pensioners and students, but also about people who are temporarily not working.
Do not forget that even the absence of compulsory medical insurance does not deprive you of the right to an ambulance, which is provided without prior presentation of insurance. If necessary, you can contact a commercial clinic, and even learn how to give injections yourself.
After the birth of the child, parents are required to issue a place of registration, a number of official documents and a medical policy. Together with him, the baby will receive the right to medical care free of charge. At the same time, he will be able to receive it both in Russian medical institutions and in countries with which there is an agreement on insurance in the field of medicine.
If you have a child or are planning to have one, the information will come in handy.
I do not rule out that the baby may not need medical insurance, and this is wonderful. But, if something happens, improve the health of the baby without cost and problems.
Our country has a CHI program. A medical policy is considered a document that confirms the holder's right to free medical care in Russia.
Foreign citizens who have decided to build a career in Russian firms or enterprises can also issue a document.
After the onset of the disease, it becomes necessary to go to the hospital and stand in line to wait for the attention of the doctor. A visit to the clinic causes negative emotions. But, the time spent along with the spoiled mood is the tip of the iceberg.
Sometimes you need to consult a highly specialized doctor, which is not easy to find. What to say about taking tests if a person has no idea where to go, what to take with him and how much it will cost.
These problems are solved by the OMS. Let's find out what pluses and merits the document has.
Lead a healthy lifestyle and do not get sick. Good luck!
MOSCOW, April 13 - PRIME, Natalya Karnova. The state will gradually reduce participation in the health insurance system, so it is likely that unemployed Russians who do not have benefits will still have to pay for compulsory health insurance policies (CHI) on their own. True, they will not be alone in this - to one degree or another, all over the world, both poor and rich, have to pay for medicine. Even in countries where health care is fully paid from the budget, citizens have to go abroad for treatment due to long waiting periods.
Opinions of experts and society on the idea of obliging the unemployed to fully or partially pay for policies (CHI) differ diametrically. Some believe that the state and working citizens really should not bear the cost of treating the unemployed, others are sure that the innovation is "crude" and looks anti-social in its declared form, violating the rights of Russian citizens to medical care.
At present, 146.5 million Russians are insured in the CHI system, of which, according to various estimates, about 8-12 million people do not pay contributions to social funds (including the MHIF). There are also self-employed, the situation with which is ambiguous. Lawyers in private practice, notaries, arbitration managers and entrepreneurs often pay fees themselves. Categories such as nannies, nurses and tutors do not always do this.
WHAT IS INCLUDED IN CHI
To understand why this topic causes such a stormy response, you need to know how the CHI system works. Now almost every citizen of the Russian Federation has the right to medical care, but not "free", as many people think, but only under the CHI policy. The policy is issued free of charge, and the money for the maintenance of the medical infrastructure and payment for the provided medical care goes through medical insurance organizations from the Compulsory Medical Insurance Fund, where employers' contributions for their employees are transferred. Means for the treatment of the unemployed are directed from the regional budgets.
CHI provides almost the entire average statistically necessary volume of medical care, said Dmitry Kuznetsov, vice president of the All-Russian Union of Insurers (ARI), president of the Interregional Union of Medical Insurers. “Recently, many types of high-tech assistance have been loaded into the system, including first aid, the treatment of oncological diseases, which were previously paid from budget funds. Thanks to this person, who was brought in an ambulance, they will perform an emergency operation, the necessary equipment is always available. The waiting time for medical assistance has also been significantly reduced," he said.
Undoubtedly, the system needs to be improved. This also applies to concretization of the program and changes in the role of participants in the system.
VOLUNTARY INSURANCE
In parallel, there is a system of voluntary medical insurance (VHI), when a person who wishes to buy a policy from an insurance company that is valid in selected medical institutions. Almost all major insurers work under VHI programs. The scope of services depends on the price of the policy and the amount of insurance coverage - some include dentistry using the most modern materials and technologies, prosthetics, long-term treatment of severe diseases, rehabilitation (including outside the Russian Federation). There are policies for certain types of diseases. Policy prices start from one and a half thousand rubles a year, but this is a minimum program. Also, a VHI policy can be obtained "free of charge" if your company purchases insurance as part of corporate medical insurance.
"VHI is less regulated than compulsory health insurance, built on the basis of classical insurance market mechanisms and fully proved its worth. It offers more service, freedom of choice, faster access to specialists. In terms of income, VHI is already comparable to OSAGO and at the same time leads in the smallest number of complaints from clients of insurance companies, "Kuznetsov noted. This suggests that the insurer is interested in the fast and high-quality provision of medical care, otherwise it risks losing a client. Medical service providers are also interested to be chosen for insurance medicine, so they are forced to improve the quality, he added.
According to the expert, in the future Russia should move even more towards an insurance model with a system management similar to VMI. But emergency assistance should be free. It is also necessary to preserve the network of state institutions. To date, the share of private providers of medical services is about 30% and this is quite a sufficient figure.
OVERSEAS EXPERIENCE
The Russian health insurance system can be safely called unique, just like any other system is unique. insurance system. Each country takes one of the schemes as a basis and, on its basis, develops its own model, taking into account the mentality, the level of economic development, the income of citizens and many other parameters.
Currently, two main fundamentally different health care systems can be distinguished - state and insurance. Predominantly public insurance system in the UK. In many ways, it is built on the example of the model that was in the USSR. The main part of the funds comes from the state budget and is distributed from top to bottom along the management vertical. Centralized funding helps ensure quality and keep costs down. However, the choice of doctor or medical institution is limited, and the waiting time for the study can be endless.
“In England, they are justifiably proud of their “medicine of equal opportunity” created after the war. However, the long waiting times for many diagnostic and therapeutic procedures do not allow us to consider it ideal. As you know, citizens different countries choose Germany, the USA or Israel - countries with insurance models for financing healthcare," Kuznetsov said.
The insurance system with a different share of state regulation operates in such European countries like Germany, France, Holland, Austria, Belgium, Switzerland, some states of Latin America and Japan. Financing is provided through three channels: insurance premiums from the employer or payments from the income of entrepreneurs, earnings of workers - deductions from wages and state budget funds.
Each country has its own nuances. "France is satisfied with its CHI system, but at the same time, 90% of the country has a VHI policy, since their CHI system contains severe restrictions on the set of included services (specialists such as, for example, an oculist, are removed from the CHI) and is somewhat less perfect than ours - the insurers are several funds, divided according to professional criteria," the expert said.
A special subspecies of the insurance system - private - in the United States. There, medical insurance is a voluntary matter of citizens, often paid in full or in part by the employer. There is no state regulation in this area, and more than 80% of the population is covered by private medical insurance. State programs work for the poor, but it is difficult to get them, and they do not cover all the costs. The system was tried to improve by former US President Barack Obama. His Obamacare program made insurance mandatory. However, the new president - Donald Trump - canceled Obamacare, although there is no approved plan to replace it yet.
“It’s all about the mentality: if our citizens need someone to take care of them, because “they are entitled to everything”, then the Americans have the opposite. They opposed Obama’s idea of compulsory insurance“They say, when needed, then we’ll buy,” Kuznetsov explained.
WHERE IS BETTER FOR THE POOR
The insurance system allows 80-90% of the population to receive qualified medical care. The pluses of experts include control over the quality of services provided by insurers, the minuses are the fact that low-income citizens do not always have equal opportunities for treatment.
Of course, it all depends on the specifics of each particular country. The largest volume of medical care at the expense of the state - in developed countries Europe, as well as in Japan. So, in Italy, for any operation in a private or public clinic, a person does not need to pay a single euro. However, there is practically no completely free medicine anywhere. In the same China, where alternative medicine is also included in the CHI system, there are mandatory payments. For example, the patient or his relatives pay 10% of the hospital services.
In Israel, each insured person in the system participates in co-financing (working people deduct a percentage of their salary, pensioners - a percentage of old-age benefits, disabled people - a percentage of disability benefits), but at the same time, their MHI policy even involves the provision of foreign assistance if necessary, Kuznetsov said. . In Switzerland, insurance medicine implies significant payments from the population, but if we compare it with our shadow payments, the amounts are comparable. In the US, even a "golden policy" purchased by a citizen covers only 90% of medical services. So, with some degree of probability, even the most wealthy will have to pay extra.
WHAT EXPECTS THE UNEMPLOYED
In this situation, sooner or later, Russians, for whom the employer does not pay contributions, will have to fully or partially pay for the CHI policy themselves, experts are sure. “I think that sooner or later, truly free medicine, like everywhere else abroad, will remain only at the level of emergency medical care. The state will pay for policies for privileged categories of the population, and the employer will pay for the rest, or the employee will have to buy the policy himself,” - says the director of the National Institute of Medical Law Yulia Pavlova.
David Melik-Guseinov, director of the Research Institute for Health Organization and Medical Management of the Moscow City Health Department, believes that discussion of the topic will raise acute questions that society may not be ready for. "Won't this lead to the fact that the unemployed and self-employed will be formally registered at 0.25 wages and will be registered as employed? The effect for tax collection in favor of the MHIF will be minimal," he wrote on his Facebook page.
The flat taxation scale will also raise questions - everyone pays the same percentage, but in absolute terms those who receive a higher salary may require special conditions service, says the expert. Thus, the reform of the system of insurance medicine itself will continue, and the share of state participation in it will most likely decrease.
The government decided to change the formula for calculating regional contributions for compulsory medical insurance of non-working citizens. This will lead to a significant increase in the costs of Moscow and St. Petersburg, RBC found out
Photo: Alexey Pavlishak / TASS
The government proposed to change the calculation of the tariff insurance premium for compulsory health insurance (CMI) for 80 million non-working Russians. The corresponding draft law was submitted to the State Duma on September 29 along with the draft budget of the Federal Compulsory Medical Insurance Fund for the next three years. Amendments to the methodology - the first in seven years - will lead to growth budget spending Moscow, St. Petersburg, Moscow and Leningrad regions by almost 70 billion rubles. compared to 2018. Contributions to the CHI system for the unemployed (children, students, pensioners, the unemployed) are made by the regional authorities.
Moscow and St. Petersburg will pay twice as much
The regional contribution for medical insurance of one unemployed person is determined by law as the product of the basic, common for all tariff of 18,865 rubles, the differentiation coefficient (individual for each region) and the coefficient of appreciation of medical services (single for the whole country, determined annually by the FFOMS budget). The government decided to revise the differentiation coefficient , which has not changed since 2012, and take into account, when determining it, the ratio of wages in the region and average salary in the country. “The proposed approach will make it possible to take into account the peculiarities of regions in which wages are higher than the average for the Russian Federation,<...>"- Leningrad region, Moscow region, Moscow, St. Petersburg, the explanatory note to the project says.
Now for these regions the coefficient of differentiation is the same - 0.3333. As a result of the amendments, for Moscow it will be increased to 0.8196 (almost 2.5 times), for St. Petersburg - up to 0.5965 (1.8 times), for the Moscow Region - up to 0.52 (1.6 times ) and for Leningrad region- up to 0.4365 (1.3 times). In addition, the coefficient of appreciation of medical services for 2019 will be indexed to the forecast inflation rate (4.3%) and, accordingly, will increase from 1.073 to 1.119, follows from the draft FFOMS budget.
As a result, the rate of compulsory medical insurance contributions per non-working citizen will increase for Moscow from the current 6.75 thousand to 17.3 thousand rubles. (that is, more than 2.5 times), for St. Petersburg - from 6.75 thousand to 12.6 thousand rubles, for the Moscow region - from 6.75 thousand to 11 thousand rubles. and for the Leningrad region - from 6.75 thousand to 9.2 thousand rubles, follows from the calculations of RBC and is confirmed by the FFOMS document. RBC sent a request to the Ministry of Health.
The tariff is reduced for only one region
In addition to changing the methodology, the government updated the so-called regional wage coefficients, which will affect 33 more regions (Tyva, Tyumen region, Chelyabinsk region, Khanty-Mansi Autonomous Okrug, etc.). As a result, the differentiation coefficients decreased for 22 regions, most notably for the Tomsk region. And due to the increase in the cost of medical services, the tariff will increase for all regions, with the exception of the Tomsk region (minus 300 rubles).
Contributions to compulsory medical insurance for the non-working population are a constantly growing expense item of regional budgets. If in 2012 the contribution of all regions amounted to 299 billion rubles, then in 2018 it will reach 661 billion rubles. Regions are required to make monthly payments for the unemployed to the territorial CHI fund. A significant amount of contributions “leads to a deficit in regional budgets for financial support programs of state guarantees for the provision of free medical care in terms of payment for medical care not included in the mandatory medical insurance, ”noted the Federation Council (* .pdf), and Accounts Chamber pointed out problems with the methodology for determining the number of insured non-working citizens, which is why the amount of contributions to compulsory medical insurance non-working population may be considered too high.
In 2019, the amount of regional contributions for the unemployed will increase to 719.3 billion rubles, and the entire increase will be provided by the budgets of Moscow, St. Petersburg, Moscow and Leningrad regions. Thus, Moscow's contribution will increase from 34 billion rubles. in 2018 to 68.9 billion rubles, in the Moscow region - from 24.5 billion to 44.6 billion rubles, in St. Petersburg - from 17.7 billion to 30.6 billion rubles, in the Leningrad region - from 5.4 billion up to 6.6 billion rubles.
Spending obligations could have grown even more if it were not for the changes in the method of personalized accounting for CHI, adopted last summer. Firstly, military personnel and persons equated to them were excluded from the register of the insured, and secondly, the number of non-working population is now determined on January 1, and not on April 1. As a result, the number of unemployed citizens, on the basis of which the amount of contributions is calculated, decreased by almost 5 million people: if on April 1, 2017 it was 85 million people (previous budget of the FFOMS), then on January 1, 2018 - about 80 million (current project budget). Including about 8 million unemployed (10% of the national figure) are registered in Moscow and the Moscow region.
Liberation of regions?
Deputy Prime Minister Tatyana Golikova earlier with a proposal to exempt the regions from paying insurance premiums for the non-working population and transfer these costs to federal budget. “The payment for the non-working population, the consolidated payment for Russia as a whole, has already begun to exceed the subsidy that the federal budget gives to equalize the level of budgetary security, that is, in fact, there is a flow through the regional budget to the budget of the CHI fund,” she said at the end of May 2018 . In the spring of 2017, she estimated the total volume of such payments at 7% of the expenditure side of regional budgets.
First Deputy Prime Minister and Finance Minister Anton Siluanov in June that the Ministry of Finance agreed to release regional budgets from the obligation to pay annual contributions to the MHIF for certain categories of non-working citizens (children, pensioners). “This is a significant amount of resources - about 500 billion rubles. In order to ensure a balance between the obligations transferred to the regions for the implementation of those national tasks that have been set for the coming period by the president, we are ready to take these powers to the federal level and free up the necessary resources for the constituent entities of the Russian Federation,” Siluanov said.
However, the FFOMS budget for 2019-2021 has been formed subject to the preservation of the obligation of the regions to pay contributions to compulsory medical insurance for the non-working population. Moreover, a “special procedure” is proposed for the entry into force of the changes, so that the regions can pay for the unemployed according to the new methodology from 2019, follows from explanatory note. RBC sent a request to Golikova's secretariat and the Russian Ministry of Finance and received conflicting answers. The vice-premier's secretariat did not confirm plans to exempt the regions from contributions for the unemployed, answering: "Now another solution is being discussed." “This issue [of transferring powers to the federal level] is still being discussed,” the Ministry of Finance said.
With the participation of: Polina Zvezdina
Compulsory health insurance (CHI) – important element social protection of the population, providing an opportunity free receipt medical services in accredited healthcare institutions.
If the policy is issued for a child under 18, you must additionally attach a copy of the passport of his legal representative.
On the day of the application, the insurer issues a temporary certificate indicating that the CHI policy is in the process of being issued. A temporary document allows you to receive free medical care on a general basis. Its validity period is 30 days (indicated on the form).
Must visit on the day insurance company and pick up a ready-made compulsory medical insurance policy, the validity period of which is not limited.
To receive a medical insurance policy for an unemployed person, it is necessary to draw up an application for choosing an insurance organization. The form of a unified form is filled out by hand or using technical means. The name of the person submitting the application is indicated in the upper right corner.
Filling instructions:
The full name, date and place of birth of the insured person is indicated. On the basis of an identity document, the place of registration and the actual place of residence are entered. Citizenship, SNILS number (if any) and contact information are indicated.
To be completed provided that the application is submitted for consideration by a representative. His full name and information about the identity document are entered. Additionally, the relationship of the representative to the insured person is indicated.
An application with a package of documents for issuing a medical policy to an unemployed person is submitted for consideration to the insurance organization in the chosen way:
The compulsory medical insurance policy allows working and unemployed citizens of the country to remain calm about their health, knowing that at any time they can apply for free medical care!
Unemployed citizens in the Russian Federation are able-bodied persons who are not employed and do not receive wages, BUT at the same time registered with the employment service in order to find a suitable job.
Currently, the State Duma is considering a draft law from deputy Ildar Gilmutdinov, which provides for the impossibility of obtaining a compulsory medical insurance policy for non-working citizens for free.
The proposed innovations, according to the deputies, will be rejected in the upcoming reading, if it is not amended. The reason is the contradiction in the content of the draft of the current Constitution, which provides for the right of everyone Russian citizen for free medical care.
A lawyer will advise you in the comments to the article
