The terms of validity of compulsory medical insurance policies are fixed by the provisions listed in the “Rules of Compulsory Medical Insurance”, put into effect by Order of the Ministry of Social Development of the Russian Federation No. 158n dated February 28, 2011. Changes are periodically made to these Rules for the provision of medical care. Thus, the wording of the regulations was updated in 2017. What are the essence of the changes that occurred in 2017? What caused these changes and what might they entail? We will answer these questions in this article.
What do the compulsory medical insurance rules regulate?
Most citizens experience diseases of varying severity throughout their lives. These may be disorders as a result of acquired infections, exacerbation of chronic diseases, injury, pregnancy and childbirth. In all of these cases, for the further normal functioning of the human body and for the purpose of partial or complete recovery, medical care is necessary.
The state guarantees the receipt of timely and qualified services from doctors within the framework of a functioning compulsory health insurance system. Thus, compulsory medical insurance is an opportunity for citizens to receive timely medical care. The range of services within the program is quite diverse and consists of the following items:
- Ambulance and emergency medical care;
- Undergoing outpatient treatment;
- Hospital stay;
- Providing diagnostic and preventive services;
- Providing medicines to preferential categories of citizens;
- Conducting vaccinations;
- Other medical services operating within the framework of compulsory medical insurance.
Medical care is provided free of charge within the framework of compulsory medical insurance. The source of funding is employers and constituent entities of the Russian Federation. Contributions to the compulsory medical insurance fund are made periodically within the established tariffs.
Who are the insured persons?
A fairly wide range of people can use compulsory medical insurance services. First of all, this includes citizens of the country, including unemployed people, people of retirement age, children and others. The insured also includes foreign citizens temporarily or permanently residing in the territory of the Russian Federation, refugees and stateless persons. As insured in the compulsory medical insurance system according to Art. 10 of Law No. 326-FZ of November 29, 2010, also considers self-employed citizens, as well as members of peasant farms, persons undergoing full-time education, disabled people, guardians of disabled people and others.
Foreign highly qualified specialists and members of their families are not recognized as insured. For them, employers do not pay insurance contributions to the Compulsory Medical Insurance Fund (MHIF). But these categories of people have the right to receive medical care in the country if they have a voluntary health insurance policy (VHI).
Rights and obligations of participants in insurance relations
There are still 3 types of participants in the health insurance system in 2017. These are insurers, policyholders and insured persons. Citizens and other persons who have the right to count on receiving medical care under compulsory medical insurance are considered insured. To confirm the status, a medical insurance policy is issued, which allows you to receive the necessary list of free services throughout the Russian Federation.
Insurance companies act as insurers. Their responsibilities include payment for medical services, protection of rights in terms of receiving timely and high-quality medical services. The policyholders are, as a rule, the employers of the insured persons and the constituent entities of the Russian Federation. Their main task is the timely transfer of contributions to the FFOMS.
Changes in compulsory medical insurance affecting certain categories of the population
Since 2017, there have been some changes in the compulsory medical insurance system. Amendments were made to the previously existing Compulsory Medical Insurance Rules based on Order of the Ministry of Health of Russia dated October 27, 2016 No. 803n. The adopted amendments affect foreign citizens and stateless persons. The policies they receive can only be submitted in paper form with a validity period until the end of the current period (year). However, the condition remains that the final term of the document cannot be longer than the expiration of the temporary residence permit. Innovations also affect citizens whose states are part of the EAEU (Armenia, Belarus, Kyrgyzstan, Kazakhstan). For Russian citizens, compulsory medical insurance policies still remain unlimited.
Format of compulsory medical insurance policies in 2017
Starting in 2017, a new format of compulsory medical insurance policies began to operate in the Russian Federation. Their size has decreased significantly, and they now include a Russian chip that allows them to read information. It was planned that the required technical equipment would be introduced on the territory of all constituent entities of the Russian Federation by the end of 2017. The new document format allows you to read information about the owner electronically. Therefore, there should be no problems with obtaining information about the patient. In the event that the owners of new policies present them in regions where there is insufficient technical equipment, customer data can be found by the policy number from the general compulsory medical insurance database.
For those citizens who still have old-style policies in their hands, there should also be no problems. There are no plans to limit the validity period of previous forms of documents. At the same time, if desired, you have the opportunity to change the old paper document to a more modern one.
The advantages of new types of policies are obvious. First of all, it is a more compact format. Holders of a small card with a chip will no longer have to risk ruining the document due to its deformation. All information can be read electronically thanks to the embedded chip. The technology for manufacturing new policies contributes to their greater preservation. It will be almost impossible to accidentally spoil a document. In addition, the policy contains the following information about the owner:
- Passport details;
- Photo of the owner;
- Electronic signature of the owner;
- Name of the insurance company.
The current rules of compulsory health insurance for citizens of the Russian Federation will remain unchanged. But you will be given the opportunity to obtain a more modern document or exchange your old policy for a new one. The provisions of compulsory medical insurance will also allow insured persons to receive the necessary services within the framework of current legislation. Small innovations will affect only stateless persons and foreigners. It is not yet possible for them to issue a new type of policy, and the validity period of the document is now limited to a calendar year.
Conclusion
Compulsory medical insurance rules, updated in 2017, affected foreign citizens and stateless persons, who, starting from this year, are issued only paper policies valid until the end of the year. In addition, since 2017, compulsory medical insurance policies have been issued to citizens arriving for work from EAEU countries. Starting from this year, Russian citizens can exchange their policies for a new document - a plastic card with a chip.
Compulsory health insurance policies, both old and new, will be valid throughout Russia, since they are indefinite, the Compulsory Health Insurance Fund (MHIF) reported.
As noted in the message on the fund’s website, persons who have not yet received the “new policy” will be able to receive medical care in full.
If a citizen wants to get a new policy, he can contact the medical insurance organization indicated on the existing policy. This can be done at any convenient time in accordance with the operating hours of policy issuing points.
In addition, every Russian can change the insurance company, for example, if he is not satisfied with the quality of work of the organization that issued him the policy. However, this can be done no more than once a year and before November 1. After this, citizens will be able to receive a document from the new insurance company no earlier than January 1, 2019. As noted, the time frame for changing a medical insurance company (from January 1 to November 1 of each year) is prescribed in Russian legislation.
The press service of the Moscow city service centers “My Documents” once again noted that the break only applies to changing the insurance company, and the compulsory medical insurance policy itself can be changed to a new document “at any time during the year.”
It is worth remembering that changing the compulsory medical insurance policy is carried out at the request of the insured person.
Earlier, the Moscow Compulsory Medical Insurance Fund reported that from November 1, the issuance of new policies would be suspended and would supposedly resume only in January.
It also became known that although the new policy form has been in effect throughout the country since 2011, Russians are in no hurry to change their old policies. Thus, in Moscow, out of 12.3 million people insured under compulsory medical insurance, less than half (5.8 million people) use a new type of policy, the rest (6.5 million) present the “old” policy at medical institutions.
The director of the MGFIF explained that the introduction of a new unified policy is necessary to avoid confusion if a person goes to a clinic or hospital other than the place of insurance.
There is a system of mutual settlements between Russian entities for payment for medical care received outside the insurance region. “... a medical organization cannot remember what the old compulsory medical insurance policies of 86 regions of Russia look like, so I would recommend that all owners of old policies change them,” Zelensky emphasized.
According to the law, in an emergency situation, a medical institution does not have the right to refuse assistance or hospitalization to a patient with an old policy. But refusal is possible if the case is not an emergency.
This summer, the President of Russia signed a law designed to improve the mechanism for monitoring whether Russians have a compulsory medical insurance policy.
Thus, a citizen who has moved into the category of Russians not subject to compulsory health insurance must now submit an invalid compulsory medical insurance policy or report its loss to any medical insurance organization.
The exception is for citizens undergoing military service by conscription.
New rules have also appeared for federal and territorial compulsory medical insurance funds, which are required to monthly reflect new information on the number of suspensions of insurance or refusal of it.
In May of this year, Health Minister Veronica announced plans to change the compulsory health insurance system. In her opinion, it is necessary to make the compulsory medical insurance system more centralized and controlled by the Federal Compulsory Medical Insurance Fund in order to avoid distortions in territorial state guarantee programs.
Currently, territorial compulsory medical insurance funds are subordinate to the heads of departments and regional ministries of health, Skvortsova noted.
“Our plans include raising the issue of verticalization of the compulsory medical insurance system, transforming the system of territorial compulsory medical insurance funds into territorial divisions of the federal compulsory medical insurance fund, and introducing the “two keys” rule,” she said at the St. Petersburg International Economic Forum (SPIEF).
A document confirming that the patient has medical insurance allows him to timely take advantage of the state-provided package of medical services, which will be paid for by the insurance company. Not every person today knows that all variations of the new type of policy existing in the country are equivalent. And the presence of a document of one form or the absence of another cannot cause a refusal of service at the selected institution. How do they differ from each other and which variety has more advantages? We will answer these questions in this article.
When and why did the release of a new compulsory medical insurance policy begin?
Until 2011, there were several formats of compulsory medical insurance policies in the Russian Federation. The most common variety was a green plastic card, which appeared back in 1998. In connection with the current situation, the question arose about streamlining relations in the field of health insurance. At the beginning of 2011, the new Law of the Russian Federation “On Compulsory Health Insurance in the Russian Federation”, adopted on November 29, 2010, came into force. It provided all citizens, without exception, with the opportunity to choose an insurance medical organization according to their preference for further permanent care. Also, the regulatory act marked the beginning of the issuance of insurance policies of a unified state standard, which would be valid throughout the country, regardless of the registration of their owners.
As a result of legislative changes, on May 1, 2011, the issuance of policies of a new format began: a blue paper document printed on A5 format became an alternative to the green plastic card. It received perpetual status (issued to the owner for life). Old options received by citizens before May 1, 2011, which had not yet expired, were also recognized as valid.
Over the next four years, the paper format managed to demonstrate its impracticality. It turned out to be inconvenient for transportation due to its large parameters - bending the document in half was prohibited, since there was a barcode in the very center that could be erased. Problems also arose with the preservation of forms - rubbing, creasing, contamination, since their lamination is also unacceptable. In order to eliminate these shortcomings, from August 1, 2015, it became possible for Russian citizens to obtain a plastic compulsory medical insurance policy with an electronic chip. Compact dimensions and durable material allow a person to always have an electronic policy with him.
Along with the above option, a universal electronic card (UEC) has appeared, which, in addition to the insurance function, serves as a bank card, pension certificate, etc. Its development is associated with attempts to integrate maximum information about the owner in one device and simplify a person’s access to various electronic services. The card is issued to all Russian citizens over 14 years of age upon personal application.
What does the new compulsory medical insurance policy look like?
All the options discussed above, the release of which began after May 1, 2011 - paper, electronic policy and UEC - are valid and equivalent today. They guarantee the same set of free medical services provided for by law and will be maintained until the population completely switches to a single model.
New paper policy
The blue paper document in A5 format is a form with watermarks, which in size corresponds to half a standard sheet from the album. It is two-sided - each of them contains a list of necessary data about the owner. The front side of the new paper policy contains:
- State emblem of the Russian Federation;
- Last name, first name, patronymic of the insured, his gender and date of birth;
- Document number, consisting of 16 digits;
- Unique barcode;
- Hologram;
- Validity period of the form.
On August 1, 2012, forms began to be issued, the barcode on which was moved from the center closer to the top to avoid erasing the image as a result of folding the sheet. Both options look like this:
- Information about the medical insurance institution to which the owner is attached (name, address, telephone);
- Signature of the responsible employee of the medical organization;
- Stamp of a medical institution.
On the back, it is possible for a citizen to change the medical organization to which he can be attached - up to 10 times. To do this, you need to provide a form to the clinic and record the changes. When you change your place of residence, it is on the reverse side that new data about the insurance company and its contact details are recorded.
The paper version of the policy cannot be laminated and it is advisable not to bend it. For such a document, a photo of the owner is not required.
The electronic compulsory medical insurance policy is made in the form of a three-color plastic card of a standard size (resembles a regular bank card) and easily fits into a wallet or purse. It contains a chip on which information about the owner is stored. The front side of the new electronic policy contains:
- Document number of 16 digits;
- Image of the state emblem of the Russian Federation;
- The name of the insurance company that issued the electronic policy;
- Compulsory medical insurance system logo;
The following information is provided on the back of the policy:
- Phone number of the compulsory medical insurance fund that issued the electronic policy;
- Photo of the insured person (except for children under 14 years of age);
- Owner's signature;
- Personal data (last name, first name, patronymic, date of birth, gender);
- Month and year when the card expires (issued for five years);
- A hologram indicating that the electronic policy is genuine.
If any personal data changes, a person needs to contact the employees of their insurance organization to order a new electronic compulsory medical insurance policy. The information contained on the chip cannot be corrected.
UEC is a multifunctional plastic card, the structure of which includes an integrated compulsory medical insurance policy. Using it, you can open a bank account, provide it as a ticket for public transport or as SNILS. It contains maximum information about the owner and frees him from the need to carry many cards in his wallet. Its receipt is not mandatory and is carried out at the request of the person. On the front side of the UEC card are presented:
- Electronic chip with personal information;
- Logo of the organization that issued the card;
- Logo of the banking institution chosen for service;
- Card number;
- Image of the state emblem;
- Name of the payment system;
- Protective numbers.
The following information is provided on the back of the policy:
- Phone number of the organization that issued the card;
- Photo;
- Owner's signature;
- Personal data (last name, first name, patronymic, gender, date of birth);
- Month and year when the card expires;
- Compulsory medical insurance policy number;
- SNILS number;
- Bank card number.
There is a magnetic stripe on the back of the UEC. This allows you to use it in terminals and ATMs for withdrawing cash, making non-cash payments, transferring funds, etc.
Advantages and disadvantages of new policies
Each of the forms of insurance policies that are in force in the country today has its own positive and negative features. Based on the ratio of the “pros” and “cons” of the documents, the citizen decides whether to rush to change the paper version to one of the electronic ones and which one to give preference to. The main disadvantage of the paper version is its impracticality in use. But it is compensated by the convenient opportunity to make changes to the form in writing if a person is assigned to another medical institution.
The electronic compulsory health insurance policy is distinguished by its main advantages - compactness, mobility, strength and wear resistance of the plastic card. It has a high level of security - the presence of a chip, photo and signature prevents the document from being used by another person. Its significant drawback is that not all medical organizations are equipped with special equipment to read information from the chip. Therefore, holders of such documents may be asked by doctors to provide an additional passport. In addition, not all branches of insurance companies are yet able to issue an electronic policy. Additional inconvenience may arise for owners if personal data changes - this will entail the need to replace the card itself.
The UEC is characterized by a generally similar set of “pros” and “cons” as the previous electronic version. Among its arsenal of advantages, it is distinguished by its versatility compared to other forms of insurance documents. But the current level of infrastructure development indicates the presence of a small number of institutions equipped with equipment capable of working with applications built into it.
Conclusion
The transition of the population of the Russian Federation to a new unified electronic medical policy will be gradual. Therefore, citizens do not need to immediately strive to exchange their document as quickly as possible. The issuance of plastic cards is already mandatory for newborns, as well as in the event of a necessary replacement of a damaged or lost policy. All varieties today provide absolutely equal guarantees.
On August 1, the exchange of compulsory medical insurance policies for new plastic cards began in Moscow. The director of the Moscow City Compulsory Health Insurance Fund (MGFOMS), Vladimir Zelensky, spoke about why this was required, how long the old policies will be valid and where to get new ones in an exclusive interview with Vestey.Ru columnist Evgeny Saltykov.
- Tell us why you needed to change your policies at all? What don't you like about the existing ones?
There are several reasons why this had to be done and why now. The first is the not very convenient format of the current paper policy. It cannot be folded because the barcode is located on the folded areas and cannot be laminated because the insurance company information is written on the reverse side. In this regard, we have accumulated quite a large request from the society. People change their last names and passports, but do not report this to the insurance company, because, in such a case, they would have to exchange the old convenient policy in the form of a green plastic card for a new paper one.
- Why did they initially change the convenient plastic for inconvenient paper?
The green plastic policy was a purely Moscow product that had existed since 1998. After this, in 2011, paper policies of a single federal standard began to be issued throughout Russia. But out of 12 million people insured under compulsory medical insurance in Moscow, more than 7 million still have old green plastic cards in their hands. During this time, many people's data changed, but, as I already said, not everyone began to report these changes. Meanwhile, the law on compulsory medical insurance stipulates the obligation of citizens to notify their insurance company within 30 days of changes in their data, such as a change of surname, place of residence or passport. But citizens neglected this duty, for the reasons stated above. Because of this, we began to encounter a lot of problems - it became difficult to find people in the registers of insurance companies, and feedback from the insured became difficult. And this, perhaps, became the main reason for the need to replace policies.
- What are the main differences between old and new compulsory medical insurance policies?
The new policy has a chip that stores all the necessary information about the insured - full name, date of birth, region of insurance, insurance company. This information can be read using readers that will be equipped in all medical institutions. The back of the policy contains additional information, including a photograph and personal signature. Thus, when presenting a new policy, you will not need to provide additional documents to identify the citizen, which is necessary when seeking medical care outside your home region. Having a photograph will also be useful in conditions of loss of consciousness - if a person has a policy with him, his identity can be easily established.
- Is replacing a new policy a mandatory procedure? How long will old compulsory medical insurance policies be valid?
The replacement is not forced. The law states that old policies are valid as long as they are in hand. Accordingly, paper policies and green plastic cards continue to be valid, provided that their owners have not changed their personal data.
- What is needed in order to exchange an old compulsory medical insurance policy for a new one?
Go to the insurance company and write a statement. Within 30 working days you will be issued a new policy.
- Will only Muscovites be able to get it, or will non-resident citizens living in the capital have this opportunity?
- If a person lives and works in Moscow, but does not have a residence permit or registration here, then he, like others, can get insurance in Moscow. Accordingly, attach to a clinic and have access to an appointment with a doctor via the Internet or in information booths.
In two years, they plan to issue a Universal Electronic Card (UEC) throughout the country, which will immediately replace both the role of an identifier and a payment card. Maybe it was worth waiting for the launch of this all-Russian project and also adding a compulsory medical insurance policy to the UEC? Or has the need for a new policy truly become urgent?
The current version of the law on compulsory medical insurance provides for two types of policies: paper and electronic. Moreover, the electronic one can be either the one that we are now starting to issue, or in the form of an application on the Universal Electronic Card. Over the several years of its existence, UEK has not become a mass product. The problems we talked about cannot be solved with its help. That is why we decided to launch a new product now.