Medical insurance policy is a document that certifies the concluded contract for medical insurance of a citizen of the Russian Federation. Medical insurance can be compulsory (CHI) and voluntary (VHI). What is the difference between OMS and VMS? Compulsory insurance contract is concluded between two legal entities - organization, institution, enterprise and insurance company. With compulsory medical insurance, contributions are made to the compulsory medical insurance fund, and the insurer plays the role of an intermediary. In the case of registration of VHI, in addition to the mandatory contributions to the compulsory medical insurance fund, the contributions remain with the insurance company. VHI can be obtained by anyone on their own or through a company that pays these contributions from the payroll.
Compulsory medical insurance policy contains the following data:
- PIN code, series, number and name of the insurance company;
- Full name the insured person, date of birth, place of work and home address;
- number of the concluded contract, its validity period;
- listing clinics, dentists, emergency rooms, consultations to which a citizen is attached.
This medical insurance policy must be certified by the seal of the organization andthe signature of the head, and also contain the signature of the citizen. On the reverse side of the policy, as a rule, information is indicated:
- phones of the insurance company;
- her postal and email addresses;
- phones of reference pharmacies, hotline, claims and the department for the protection of the rights of the insured.
Where to get a medical insurance policy should be decided by the person himself. You can get a medical policy through work (usually policies are issued for all employees centrally in one of the insurance companies) or on your own by choosing a more reliable insurance company. The following services are included in the individual policy:
- outpatient care;
- ambulance;
- inpatient care (in hospitals);
- home help;
- diagnostics (ultrasound, clinical examination);
- dental care (all services except prosthetics and cosmetology).
There are VHI programs for adults and children.
The non-working population (pensioners, the unemployed, children) also have the right to be insured under the CHI system. These categories of citizens previously received a medical insurance policy from one insurance company, and now they can apply to any company.
The rights of citizens under compulsory he alth insurance and obligations in accordance with Art. 16 Law No. 326
A citizen who has received a medical insurance policy has the following rights:
- in case of an insured event, receive free medical care in the Russian Federation;
- choosemedical institution, doctor, insurance company by submitting an application of the appropriate form;
- on the protection of personal data passing through electronic processing;
- for damages caused by poor performance or non-performance of medical duties.
Responsibilities of Citizens:
- present medical insurance policy in case of contacting doctors for help (except in emergency cases);
- when changing insurance company, apply on your own or through a representative;
- within 1 month, notify the insurer about the change of full name. and place of residence;
- when changing the place of residence, insure within a month.
All medical insurance innovations can be found by reading the law FZ-326 (2010).
