Medical assistance within the framework of the OMS is provided by medical organizations for free and classified by type, conditions and form of providing such assistance.

The types of medical care include:

Primary health care;

Specialized, including high-tech, medical care;

Ambulance, including ambulance, medical care;

Palliative medical care.

Forms of medical care are:

Emergency - medical care provided with sudden acute diseases, states, exacerbation of chronic diseases that pose a threat to the patient's life;

Emergency - medical care provided with sudden acute diseases, states, exacerbation of chronic diseases without explicit signs of the threat of the patient's life;

Planned- Medical assistance, which is provided during preventive measures, for diseases and conditions that are not accompanied by the threat of a patient who do not require emergency and emergency medical care, and delaying the provision of which at a certain time will not entail the deterioration of the patient's condition, the threat of his life and health .

The amount of medical care provided to the insured persons within the framework of the OMS, is established by the basic program and territorial OMS programs. OMS programs are approved on an annual executive authorities Russian Federation:

The basic program of the OMS - the Government of the Russian Federation;

The territorial program of the OMS is the government of the constituent entity of the Russian Federation.

With the basic program, the OMS can be found on the website of the Government of the Russian Federation, with the territorial program of the OMS can be found on the website of the territorial Fund of the OMS of the subject of the Russian Federation, or on our website, section.

Citizens of the Russian Federation;

According to the order of the Ministry of Health of the Russian Federation of 10/27/2016 No. 830n (on amending the rules of compulsory medical insurance), which has entered into force on 01/01/2017, also on the execution of the policy of the OMS entitled:

Temporarily staying in the Russian Federation Workers of the EAEU member states;

Temporarily staying in the Russian Federation foreign citizens belonging to the category of members of the Board of Commission, officials and EAEU officers.

The procedure for choosing a citizen of a medical organization when providing him with medical care in the framework of the program guarantees of free provision of medical care to citizens is regulated by the Order of the Ministry of Health of Russia dated April 26, 2012 No. 406n.

According to Article 16 of Law No. 326-FZ dated November 29, 2010, you have the right to replace a medical organization once a year (or more often in case of changes in the place of residence).

In order to attach it is necessary:

1. Select the polyclinic from the number of medical organizations involved in the OMS system.

2. Personally or through the representative, contact the clinic and write an application for attachment.

3. When submitting an application for attachment, a clinic that adopted a statement is verified by the information specified in the application. After the completion of the inspection of the clinic, who adopted a statement, notifies a citizen of attachment.

4. After attachment, you get the ability to receive a doctor in electronic form.

5. In the event that you change the clinic, you do not need to be discharged from the previous one, the clinic you chose to ask your medical records.

Insured persons are obliged to notify insurance medical organization On changing the surname, name, patronymic, data of a document certifying the personality, place of residence within one month from the day, when these changes occurred (Article 16 of the Federal Law No. 326 dated November 29, 2010 "On compulsory health insurance in the Russian Federation") .

In the event of a change in the name, name, patronymic, changes in the date of birth, place of birth, the establishment of inaccuracies or the erroneousness of the information contained in the policy is to re-issue the policy on the application of the insured person upon presentation of documents confirming the changes. Contact one of the items of issuing policy of our company to reissue the policy. With you, it is necessary to have: a passport and a reduction (with new data), a previously executed policy of the OMS.

In the event that medicines are necessary for the treatment of the disease and have been appointed in hospital conditions, but a citizen acquired them independently, he may claim to compensate for funds in the presence of confirmation documents. The citizen must be in the hands of the checks, confirming that the drug was purchased at the pharmacy, as well as an extract from the head of a stationary patient from the appointment of a doctor. For receipt of compensation, a citizen may apply to the hospital for the treatment of which medicines were purchased. In case the medical organization refuses to before judicial order return funds, then in insurance medical CompanyI gave him an OMS policy that would help in court to return funds.

No certain restrictive deadlines are established by law. In the case when a citizen needs medical care, a medical organization is not in the right to refuse to issue a direction for inpatient treatment in the same diagnosis.

In the event of a loss of the CHI policy, it is necessary to contact the office of our insurance company, in which your grandmother received an OMS policy to submit an application for the issuance of a duplicate.

The manufacture of the CHAM policy is made within 30 business days. For this period, a temporary testimony will be issued confirming the execution of the policy and certifying the law of a citizen to receive free medical care in the framework of the OMS program.

With you, you must have: a passport of a citizen of the Russian Federation, SNILS. With the work of the departments, you can familiarize yourself with.

According to paragraph 7-11 of the Order of the Ministry of Health and Social Development of the Russian Federation of April 26, 2012, No. 406 "On approval of the procedure for choosing a citizen of a medical organization when providing him with medical care under the program of state guarantees of free provision of medical care to citizens", a citizen is not obliged to present a absentee coupon. The data confirmation procedure is carried out between medical organizations.

For registration (attachment) in the female consultation of a medical institution for pregnancy at the place of actual residence, you need to write a statement addressed to the chief doctor of the specified institution. In case of refusal, you are entitled to contact the head of MO with a statement / complaint. If you refuse to help solve the issue, contact the Department of Protection of the Insured Insurance Company, which made you the Polis of OMS.

For medical care in medical organizations carrying out dental and gynecological assistance, the attachment is not necessary. Attachment is carried out only to medical organizations providing primary health care, which turns out to be physicians, physicians - pediatricians, general practitioners (family doctors), as well as paramedics and obstetres.

According to the Federal Law No. 326 "On compulsory health insurance in the Russian Federation" of November 29, 2010, the mandatory health insurance is subject to:

Citizens of the Russian Federation;

Foreign citizens permanently residing in the territory of the Russian Federation (having a residence permit);

Foreign citizens temporarily living in the territory of the Russian Federation (having permission for temporary accommodation);

Persons eligible for medical care in accordance with Federal law "About refugees."

The policy of compulsory health insurance is issued to citizens for free.

In case you are interested in a paid voluntary health insurance program ( policy DMS.), we suggest clarifying the conditions on the site of the SC "Arsenal".

Medical assistance in emergency form is provided by a citizen with medical organizations for free, regardless of the presence of an OMS policy.

Professions, when taking a job, are not paid from OMS (except primary reception on the state service). Payment is made at the expense of the employer. Conducting mandatory medical examinations of employees is governed by the Order of the Ministry of Health of the Russian Federation of 12.04.2011 No. 302n "On approval of lists of harmful and (or) hazardous production factors and works and the procedure for conducting mandatory preliminary and periodic medical examinations (surveys) of employees.

Mandatory medical insurance of children from birth and before the expiration of thirty days from the day state registration Birth is carried out by an insurance medical organization in which their mother or other legal representatives are insured. At the end of thirty days from the date of state registration of the birth of a child and until they adhere to the age of majority or before acquiring them the capacity in full, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or another legal representative.

To arrange an OMS policy on a child, contact our company's branch. With me, it is necessary to have a passport of one of the parents (or another legal representative), the birth certificate and the reduction of the child (if available). On the day of appeal you will be issued a temporary testimony (Sun), confirming the execution of the CHA policy. Sun gives the right to receive free medical care when insurance case. After the operation of the aircraft (30 working days), you will receive a single sample policy.

With a policy of the OMS, by contacting the hospital (clinic), working in the OMS system, you have the right to get a full range of diagnostic, medical measures, if the doctor determines you have any medical testimony to their intended purpose. If Sam medical institution It cannot be assisted, it concludes contracts with other organizations where it can not be done at the expense of patients, but at the expense of funds provided for the tariff for the payment of medical care.

According to the territorial program of state guarantees of free provision of medical care in Sevastopol for 2016 - the timing of consultation doctors do not have to exceed 14 calendar days from the date of the patient's appeal to the medical organization.

Persons without a certain place of residence that have an identity document without marking the place of residence have the right to receive an OMS policy (at the address of the actual residence declared by the citizen). In the absence of a document certifying the identity, the execution of the policy of the OMS is impossible. Medical assistance in emergency form is provided by a citizen with medical organizations for free, regardless of the presence of an OMS policy.

To determine your insurance medical organization just look at the opposite direction paper Polisa. OMS. On the back of the OMS policy 10 empty fields. These fields, in accordance with the rules of the OMS, are intended for making data when changing the insurance medical organization, namely: date of registration as the insured, name, address and telephone SMO, surname and signature of the authorized person, printing companies.

Operation to correct the curved nasal partition (septoplasty) is performed according to medical testimony when it leads to a violation of nasal respiration and various consequences (sinusitis, otitis, bronchitis, reduction of hearing, and so on). Before that, the patient passes a survey from the ENT doctor and the therapist and it is concluded that the septoplastic operation is shown. Such an operation is performed without payment, on the basis of the CHA policy.

In case, if there is indications, the doctor does not give a direction to carry out the operation, we suggest you to apply for clarifications to the head of the medical organization. If you refuse to consider the issue - contact the Department of Protection of the Insured Insurance Medical Organization, which made you the Polis of OMS.

According to Art. 16 ФЗ №326 of 10/29/2011 The insured persons are obliged to make a choice of an insurance medical organization at a new place of residence within one month in the event of a change in the place of residence and the lack of an insurance medical organization in which a citizen was previously insured.

When contacting your chosen insurance company Experts will put an appropriate mark and register the CHI policy in the territory of the Republic of Crimea.

With you, it is necessary to have: a passport of a citizen of the Russian Federation, SNILS, Polis of OMS.

You can contact any of the branches of Arsenal MS LLC, addresses and modes of separations are indicated by.

With a policy of the OMS, by contacting the hospital (clinic), working in the OMS system, you have the right to get a full range of diagnostic, medical measures, if the doctor determines you have any medical testimony to their intended purpose.

By writing the direction, for example, to the examination, the doctor is obliged to inform, in which medical organization it can be passed free in the system of compulsory medical insurance.

If the medical institution itself cannot assist, it concludes contracts with other organizations where it can not do at the expense of patients, and at the expense of funds provided for the tariff for the payment of medical care, that is, if there is an OMS policy and directions (form №057 / y) Diagnostic research must be carried out for free.

In the case of payment of research from personal funds, it is necessary to preserve all checks and receipts for the services received and contact the insurance company with a statement about considering the possibility of reimbursement of cash.

Recently, we get a lot of questions from employees about whether it is necessary to hand over the heads of the OMS policies.

Here is one of these issues we received by email. Mail:

"In the indication of 326 ФЗ dated 11/20/2010 h. 3 of Art. 49.1 Surrender the medical policy to 17-00 January 11, 2019. The question of control at the Ministry of Internal Affairs. The company and the apparatus pass policies with the list of personal composition-responsible senior groups. If the policy is lost or did not get - they write a report in the name of Demin that the policy did not receive and civil medical services do not use. "

And now we will analyze these instructions and explain their cause and consequences.

326-FZ Article 49.1. Suspension of the action policy of compulsory health insurance, recognition of the policy of compulsory medical insurance is invalid

1. The action of the compulsory medical insurance policy is suspended in the case of calling (arrivals) for military service or services equal to it for the term of the insured person of the specified service. (Internal affairs bodies - equivalent to military service, although it is not).

3. Citizens of the Russian Federation, specified in paragraph 1 of this article (with the exception of the military service passing), obligations to pass the policy of compulsory health insurance Or report its loss by submitting an appropriate application to any insurance medical organization or any territorial fund personally or through its representative.

Those. You must personally hand over the policy where you got it, but "responsible senior groups", are not your representatives. Therefore, they are not supposed to pass the policy of the OMS according to the law! Read carefully in the GC of Russia, who is your personal representative and what documents this representation is issued.

Writing any reports to the name of the chiefs about the lost or non-received OMS policies - not legal. This is not written in any law.

Why is such a hype, and the chiefs are forced at the same time to write that the employee is not treated in civilian medical institutions (not commercial)?

Everything is very simple and, as always, rests on money.

At the staff of the Department of Internal Affairs and Rosgvadia from the budget allocated funds for treatment. Also, funds from the budget are allocated to the treatment of other citizens, and to use these funds at the same time - prohibited by law.

But, in accordance withFederal Law "On the Fundamentals for the Health of Citizens in the Russian Federation" of 11/21/2011 N 323-FZ, Article 5. "Compliance with the rights of citizens in the field of health protection and ensuring related rights of state guarantees" -

2. The state provides citizens to health care, regardless of gender, race, age, nationality, language, presence of diseases, states, origin, property and regulations, place of residence, relations to religion, belief, belonging to public associations and from other circumstances.

Thus, the employee can be treated in conventional polyclinics at the place of residence, but at the same time he must inform the doctors that he is an employee.

Refuse to maintain doctors do not have rights:

Article 11. "Inadmissibility of refusal to provide medical care"

1. Refusal to provide medical care in accordance with the program of state guarantees of free provision of medical care to citizens and charging for its provision of a medical organization involved in the implementation of this program and medical workers of such a medical organization are not allowed.

2. Medical assistance in emergency form turns out to be a medical organization and medical worker Citizen immediately and free. Refusal to provide it is not allowed.

But at the same time, this medical institution sends to the Ministry of Internal Affairs, GU, - at the place of the employee's service, relevant documents for the cost of medical institution.

And from the budget allocated by the Ministry of Internal Affairs, GU, on the maintenance of departmental medicine, these money will be deducted and leaving civilian medical institutions.

Naturally, this is not profitable in the Ministry of Internal Affairs, because If there will be no money for such seizures, then everyone will receive complete support, while you can not take care of the quality of employee service.

And the staff are very often complaining about the quality of treatment in departmental institutions and even go to paid medical institutions without receiving compensation.

So, to intimidate employees and force them to be treated only in departmental institutions, and so that money from the Ministry of Internal Affairs is not written off, they are prohibited from being prohibited in polyclinics at the place of stay or residence.

But in these medical institutions, after treatment, an employee must receive a disability sheet, but a certificate that he gives to the departmental clinic.

That's all.

If something is not clear - call our lawyers.

On August 10, the Federal Law of July 29, 2018 No. 268-ФЗ "On Amendments to Selected Legislative Acts of the Russian Federation and the recognition of a paragraph of the eleventh part of the second article 16 of the Federal Law" On Individual (Personalized) accounting in the system of compulsory pension insurance "

Most of the amendments are clarifying and editorial. Mostly, the changes affected the Federal Law of November 29, 2010 No. 326-FZ "On compulsory health insurance in the Russian Federation" (hereinafter - FZ No. 326). Considerable part of the change is related to the information interaction when conducting personalized accounting by the authorities - from them and begin.

Now FZ No. 326 contains an indication that the interaction between the authorities is carried out by using unified interdepartmental electronic interaction system and connected to it regional systems Interdepartmental interaction.

The territorial foundation has a new authority - to conduct check the accuracy of information about the insured personsprovided by insurance medical organizations, based on information received within the framework of information interaction, including by sending requests to the authorities to issue and replace documents certifying the identity of a citizen of the Russian Federation.

As part of information interaction, organs have new responsibilities:

• The territorial fund must be quarterly no later than the 15th day of the third month following the reporting period, to provide information about non-working insured persons for non-working citizens. Insured persons, information about which is not provided, will be taken into account as non-working insured persons.
• The Ministry of Internal Affairs of Russia is entrusted with responsibilities quarterly no later than the 15th day of the month following the reporting period, to transfer information to the Federal Fund:
  • about persons whose citizenship is discontinued;
  • about foreign citizensah, stateless persons for whom canceled a residence permit;
  • about foreign citizens, stateless persons for whom the permission for temporary accommodation is canceled;
  • about the loss of refugee status or deprivation of refugee status by persons who have possess such status.
• Military Commissariators quarterly no later than the 15th day of the month following the reporting period should be transferred to the territorial funds information about citizens designed to military service, as well as information on the start, date and end of military service.

And then we go with the most interesting. Chapter 10 of the FZ No. 326 is supplemented by a new article 49.1 on the suspension of the action of the CHI policy and recognizing it invalid.

Now the OMS policy is invalid in the case of:

• termination of the Russian citizenship (in the absence of grounds for recognizing the insured person);
• cancellation of a residence permit for foreign citizens and stateless persons;
• cancellation of permission for temporary accommodation in relation to foreign citizens and individuals without citizenship;
• losses or deprivation of refugee status.

Policy in these cases is invalid from the date of receipt of information from the Ministry of Internal Affairs (just these are the new responsibilities of the Ministry of Internal Affairs, which we wrote above).

The action of the OMS policy is suspended in case calling (receipts) for military service or service-equated service for a term of passing by the insured person of such a service. Moreover, such citizens (with the exception of passing military service) are obliged to pass the policy of OMS or report its loss By filing an application to any insurance medical organization or territorial fund. In principle, on the military (equivalent to it), the Policy service will not be needed, because servicemen receive medical care in military medical organizations in accordance with the Federal Law of 27.05.1998 No. 76-FZ "On the status of servicemen" (and if a military medical organization No, then in the state state or municipal system Healthcare, which subsequent expenses are reimbursed federal budget Taking into account the Decree of the Government of the Russian Federation of December 31, 2004 No. 911).

At the same time, how to "return" the policy back - does not say. Sanctions for failure is not yet provided. At the same time, the Ministry of Health in 2017 expressed his "wishes" on the introduction of a fine in the amount of 5,000 rubles for the disadvantage of the Policy of the OMS. So watches - no change in the COAP is not far off.