Health insurance - a form of social protection of population health, as expressed in the guarantee of payment for medical care in the event of an insured event due to accumulated funds by the insurer.
Health insurance helps to ensure the citizen free of charge a certain amount of medical services in the event of the insured event (health problem) in the presence of a contract with the medical insurance organization. The last bears the cost of paying the case of medical care (risk) since the first installment payment of the citizen to the appropriate fund.Content
[Remove]
1 Compulsory health insurance in the Russian Federation
1.1 The basic program of OMC
1.2 Insured by MHI
1.3 Contract MHI
1.4 The rights of the insured
1.5 Duties of the insured
1.6 Liability of the insured
2 Voluntary Insurance
2.1 The health insurance travel abroad (travel)
3 Links
4 Notes
5 See also
[Edit] Compulsory health insurance in the Russian Federation
Compulsory health insurance - the kind of compulsory social insurance, which is a system created by the state legal, economic and organizational measures to ensure when the insured event guarantees the provision of free medical care to the insured person at the expense of mandatory health insurance program in a territorial mandatory health insurance and cases established by federal law, within the basic program of compulsory health insurance. [1][Edit] The basic program of OMC
As part of the basic program of compulsory health insurance are primary health care, including preventive care, acute care (except for specialized (sanitary aviation) emergency medical care), specialized medical care in the following cases:
Infectious and parasitic diseases, with the exception of diseases, sexually transmitted diseases, tuberculosis, HIV infection and acquired immunodeficiency syndrome;
neoplasms;
endocrine system;
nutritional and metabolic diseases;
diseases of the nervous system;
diseases of the blood-forming organs;
certain disorders involving the immune mechanism;
Diseases of the eye and adnexa;
diseases of ear and mastoid process;
diseases of the circulatory system;
respiratory diseases;
diseases of the digestive system;
diseases of the genitourinary system;
diseases of the skin and subcutaneous tissue;
diseases of the musculoskeletal system and connective tissue;
injury, poisoning and certain other consequences of external causes;
congenital anomalies (malformations);
deformations and chromosomal abnormalities;
pregnancy, childbirth, postpartum and abortion;
certain conditions originating in the perinatal period in children.
The subjects of the Russian Federation is also guaranteed an additional amount of free medical care. For example, in St. Petersburg at the MLA program provides outpatient and inpatient care in health care in infectious and parasitic diseases (excluding diseases, sexually transmitted diseases, tuberculosis and acquired immunodeficiency syndrome), and neoplasms, diseases of the endocrine system, disorders nutrition and metabolic disorders, diseases of the nervous system, diseases of the blood-forming organs and certain disorders involving the immune mechanism, eye and adnexa, diseases of the ear and mastoid process, diseases of the circulatory system, respiratory diseases, diseases of the digestive system, diseases of the genitourinary system, diseases of the skin and subcutaneous tissue disorders of the musculoskeletal system and connective tissue diseases, dental and oral diseases, pregnancy, childbirth and the postpartum period, including abortion, with injuries, poisoning and certain other consequences of external causes, congenital anomalies ( malformations), deformations and chromosomal abnormalities in adults. [2] As part of the MLA shall also conduct activities on prevention of diseases, including medical check-up of healthy children.
In addition, residents of the Russian Federation provided by the budget of Russia the following types of care:
emergency medical assistance provided by the stations (sections, paragraphs) emergency medical assistance;
outpatient and inpatient care provided in specialist clinics, hospitals (departments, offices) in the following diseases: diseases, sexually transmitted diseases, infectious skin diseases (scabies, microsporia), tuberculosis, diseases caused by extremely dangerous infections, acquired immunodeficiency syndrome; mental and behavioral disorders, substance abuse disorders;
provision of expensive medical care, the list is approved by the Committee on Health;
preferential supply of drugs and prosthetics (dental, eye, ear);
Vaccine decreed contingent on epidemiological and public testimony;
preventive fluorographic examinations for early detection of tuberculosis;
medical care in cases of congenital anomalies (malformations), deformations and chromosomal abnormalities in children and certain conditions originating in the perinatal period, in accordance with the list approved by the Committee on Health;
dental care and oncology care in accordance with the list approved by the Health Committee of the Russian Federation.
[Edit] insured by MMI
Insured by MHI - in the Russian Federation - the subject of mandatory health insurance (MHI) is liable in accordance with the Law "On Compulsory Health Insurance in the Russian Federation" dated 29.11.2010 N 326-FZ to enter into agreements with respect to OMC certain categories of citizens, endowed with this to certain rights and burdened with certain responsibilities.
An exhaustive list of categories of insureds defined by the Act: (1) executive authority of the Russian Federation or the local authority in respect of non-working citizens, resident in the area, (2) organization, (3) individuals who are registered as individual entrepreneurs, and (4 ) notaries in private practice, and (5) Lawyers (6) persons who have concluded labor contracts with employees and paying them on insurance premiums - in relation to their employees, as well as for themselves for the categories (3-5).[Edit] Treaty MLA
in the form and conditions of his detention is regulated by the Government of the Russian Federation;
is an agreement between the insured and the insurer - the medical insurance organization (SMO), whereby the latter undertakes to organize and finance the provision of citizens, subject to insurance, medical aid;
contains the names of the parties, duration, number of citizens to be insured, the procedure for providing and updating the list of people to be insured, as well as the procedures for payment of insurance premiums;
includes, as integral parts: (1) The territorial program of state guarantees the provision of the public entity of the Russian Federation free medical care to be approved in accordance with established procedure and determining the amount, quality and condition of providing medical assistance to the podlezhaschii insurance, (2) a mutually agreed list of health facilities providing medical care to citizens in local self-government;
rights, duties, responsibilities and other parties do not contradict the laws of the condition.
On January 1, 2011 came into force a new federal law on local self-government in Russia, according to which a May 1, 2011 introduced new rules of registration policies and introduced a policy OMC OMC single sample [3]. Those citizens who are the first such document, should contact their chosen medical insurance companies. First, the citizen is issued a "provisional certificate" attesting to registration policy, which is valid for 30 working days. During this time, citizens will be made for personal insurance policy. Once the document is ready, the insured be notified and exchanged him "interim certificate" on the policy. New policies OMC single sample will not have to change for dismissal, changing jobs or moving to a new place of residence. Replacement of old policies to new will be phased in over 2011-2013 period.[Edit] The rights of the insured
participation in all types of health insurance;
free choice of medical insurance organization;
control the conditions of the contract the MLA.
These rights of the insured defined above-mentioned law and in fact are declarative.
Since the right of the insured for compulsory medical insurance to participate in all kinds of health insurance means the only possibility of simultaneous participation in voluntary health insurance (VHI).
The right of certain categories of insured (executive body of the subject of the Russian Federation, local government, state, federal, municipal organizations, etc.) to free choice of insurers is limited to a requirement of the Federal Law of the tender to select one. The result is a tender, as a rule, substantially narrowed the list of one or two insurers.
In view of this statutory right is limited to the declared citizen to free choice of insurers, in particular the right to free choice of insurers all unemployed citizens. Finally, the right of the insured to control the conditions of the contract CBOs directly follows from the nature of the agreement of the parties - the insured and the insurer (QS).[Edit] Duties of the insured
registered as an insurer in the Territorial MHI Fund;
conclude the contract with OMI medical insurance organizations for citizens to be insured;
pay premiums in accordance with established procedure;
take measures to eliminate adverse impacts on the health of people (within its jurisdiction);
provide medical insurance organization information on indicators of health of citizens to be insured.
These duties also declared the above Act.
The obligation of the insured to register the Territorial MHI Fund - an independent non-profit financial institution that implements the state policy of local self-government, accumulating funds for CBOs and distributing them among insurers in sootvnetstvii with the need of people insured for health care - is the need to control and account payment of the insured in the entity of the Russian Federation.
The obligation of the insured to sign contracts with insurance OMC medical organizations for citizens to be insured, is his primary responsibility.
Obligations of the insured to take steps to eliminate the adverse impacts on the health of citizens and provide information to insurers on health outcomes of citizens to be insured, are declarative.[Edit] The responsibility of the insured
for breach of the duty to register as an insurer in the Territorial MHI Fund punishable by an administrative fine of five hundred to one thousand;
violating the laws of the Russian Federation on insurance premiums timing of the calculation of accrued and paid premiums to the organs of state budget funds, exercising control over the payment of insurance premiums, punishable by an administrative fine on officials in the amount of three hundred to five hundred rubles.
[Edit] Voluntary InsuranceQuestion book-4.svgThis section is missing references to information sources.Information must be verifiable, otherwise it can be questioned and removed.You can edit this article by adding references to authoritative sources.This mark is for the article in May 12, 2011
Voluntary health insurance is an additional program to set the volume of care that applies to the persons specified as insured beneficiaries. LCA is carried out by means of a specific budget, the personal contributions of the citizens, contributions by the employer.
It should be noted that the LCA does not insure health, but the cost of treatment, the latter usually reimbursed to the insured or on stage medical interventions (pharmaceuticals, diagnostics, hospital) or by type of care provided (dentistry, gynecology, cosmetics, accidental death), or shares the costs of reimbursement of medical care (full recovery, the percentage of compensation, the compensation to a specified amount).
Voluntary health insurance for individual decided to subdivide (taking into account the complexity of the particular disease specific individual) and collective (taking into account the risk of certain diseases among groups of individuals).
Under Russian law, safeguarding and protecting the rights of insured citizens are engaged in:
legislative body of the subject of the Russian Federation
executive authorities of Russian Federation
policyholders (employers)
Regional Health Insurance Fund (for the corresponding system)
medical insurance organizations and their associations
Body of Health Management
professional medical associations
health facilities (clinics, hospitals)
Licensing and Accreditation Commissions
state control (the prosecutor's office, the competition committee, the Commissioner for Human Rights, the Representative of the Russian President, Roszdravnadzor)
agents of social control (trade union bodies, the Society for Consumer Protection, the media, citizen)
subjects of pretrial and trial dispute resolution.
Paid medical services provided to citizens by medical institutions within the framework of contracts concluded in the form of preventive, diagnostic and treatment, rehabilitation, orthopedic and dental care.
For the activity in medical institutions must have their corresponding certificate and license. State and municipal health agencies provide paid medical services to people with special permission of the relevant body of health management.
Paid medical services are:
types of health care are not included in the list of government-guaranteed and subject of the Russian Federation;
medical services provided at the request of citizens, over the volume of established standards of care approved by the Ministry of Health and Social Development of the Russian Federation;
health services provided in a planned manner to citizens who are not entitled to them free of charge.
[Edit] Health insurance going abroad (travel)
This type of insurance is a voluntary form of insurance, but the availability of insurance policy for medical expenses traveling abroad (Exp) is a mandatory requirement for obtaining a visa in some countries (Schengen countries, etc.)
Discussions are under way to introduce this type of insurance in the number of mandatory, when you make a trip through a travel agency.
Specific insurance regulations of the insurance company determined the volume of services paid polysomes adults, but usually it is:
Medical services - treatment of acute illnesses or injuries arising
Medical and transportation services - delivery of the patient to the hospital, transportation from one hospital to another, if necessary - the evacuation of the patient's country of residence, with accompaniment.
Repatriation of remains
As a rule, according to the rules of insurance is not paid adult treatment:
Cancer
conditions associated with pregnancy and childbirth
psychiatric disorders and their consequences
injuries to the influence of alcohol or drugs
systemic connective tissue diseases
Solar allergies and sunstroke
diseases that occur during natural disasters - earthquakes, volcanic eruptions, tsunamis
For the organization of medical care overseas insurance companies attract company-Assistance.[Edit] See also
Law on Compulsory Health Insurance
The amount of insurance for tourists to be increased
[Edit] Notes
↑ The Federal Law of 29.11.2010 N 326-FZ (as amended on 06.14.2011) "Compulsory Health Insurance in the Russian Federation"
↑ territorial program of state guarantees the provision of Russian citizens free health care in St. Petersburg in 2012 (. Doc)
↑ The new law on local self-government shall enter into force on 1 January
[Edit] See also
Compulsory social insurance in Russia
Medical Law
Medical service
Federal Fund for Mandatory Health Insurance
Health insurance helps to ensure the citizen free of charge a certain amount of medical services in the event of the insured event (health problem) in the presence of a contract with the medical insurance organization. The last bears the cost of paying the case of medical care (risk) since the first installment payment of the citizen to the appropriate fund.Content
[Remove]
1 Compulsory health insurance in the Russian Federation
1.1 The basic program of OMC
1.2 Insured by MHI
1.3 Contract MHI
1.4 The rights of the insured
1.5 Duties of the insured
1.6 Liability of the insured
2 Voluntary Insurance
2.1 The health insurance travel abroad (travel)
3 Links
4 Notes
5 See also
[Edit] Compulsory health insurance in the Russian Federation
Compulsory health insurance - the kind of compulsory social insurance, which is a system created by the state legal, economic and organizational measures to ensure when the insured event guarantees the provision of free medical care to the insured person at the expense of mandatory health insurance program in a territorial mandatory health insurance and cases established by federal law, within the basic program of compulsory health insurance. [1][Edit] The basic program of OMC
As part of the basic program of compulsory health insurance are primary health care, including preventive care, acute care (except for specialized (sanitary aviation) emergency medical care), specialized medical care in the following cases:
Infectious and parasitic diseases, with the exception of diseases, sexually transmitted diseases, tuberculosis, HIV infection and acquired immunodeficiency syndrome;
neoplasms;
endocrine system;
nutritional and metabolic diseases;
diseases of the nervous system;
diseases of the blood-forming organs;
certain disorders involving the immune mechanism;
Diseases of the eye and adnexa;
diseases of ear and mastoid process;
diseases of the circulatory system;
respiratory diseases;
diseases of the digestive system;
diseases of the genitourinary system;
diseases of the skin and subcutaneous tissue;
diseases of the musculoskeletal system and connective tissue;
injury, poisoning and certain other consequences of external causes;
congenital anomalies (malformations);
deformations and chromosomal abnormalities;
pregnancy, childbirth, postpartum and abortion;
certain conditions originating in the perinatal period in children.
The subjects of the Russian Federation is also guaranteed an additional amount of free medical care. For example, in St. Petersburg at the MLA program provides outpatient and inpatient care in health care in infectious and parasitic diseases (excluding diseases, sexually transmitted diseases, tuberculosis and acquired immunodeficiency syndrome), and neoplasms, diseases of the endocrine system, disorders nutrition and metabolic disorders, diseases of the nervous system, diseases of the blood-forming organs and certain disorders involving the immune mechanism, eye and adnexa, diseases of the ear and mastoid process, diseases of the circulatory system, respiratory diseases, diseases of the digestive system, diseases of the genitourinary system, diseases of the skin and subcutaneous tissue disorders of the musculoskeletal system and connective tissue diseases, dental and oral diseases, pregnancy, childbirth and the postpartum period, including abortion, with injuries, poisoning and certain other consequences of external causes, congenital anomalies ( malformations), deformations and chromosomal abnormalities in adults. [2] As part of the MLA shall also conduct activities on prevention of diseases, including medical check-up of healthy children.
In addition, residents of the Russian Federation provided by the budget of Russia the following types of care:
emergency medical assistance provided by the stations (sections, paragraphs) emergency medical assistance;
outpatient and inpatient care provided in specialist clinics, hospitals (departments, offices) in the following diseases: diseases, sexually transmitted diseases, infectious skin diseases (scabies, microsporia), tuberculosis, diseases caused by extremely dangerous infections, acquired immunodeficiency syndrome; mental and behavioral disorders, substance abuse disorders;
provision of expensive medical care, the list is approved by the Committee on Health;
preferential supply of drugs and prosthetics (dental, eye, ear);
Vaccine decreed contingent on epidemiological and public testimony;
preventive fluorographic examinations for early detection of tuberculosis;
medical care in cases of congenital anomalies (malformations), deformations and chromosomal abnormalities in children and certain conditions originating in the perinatal period, in accordance with the list approved by the Committee on Health;
dental care and oncology care in accordance with the list approved by the Health Committee of the Russian Federation.
[Edit] insured by MMI
Insured by MHI - in the Russian Federation - the subject of mandatory health insurance (MHI) is liable in accordance with the Law "On Compulsory Health Insurance in the Russian Federation" dated 29.11.2010 N 326-FZ to enter into agreements with respect to OMC certain categories of citizens, endowed with this to certain rights and burdened with certain responsibilities.
An exhaustive list of categories of insureds defined by the Act: (1) executive authority of the Russian Federation or the local authority in respect of non-working citizens, resident in the area, (2) organization, (3) individuals who are registered as individual entrepreneurs, and (4 ) notaries in private practice, and (5) Lawyers (6) persons who have concluded labor contracts with employees and paying them on insurance premiums - in relation to their employees, as well as for themselves for the categories (3-5).[Edit] Treaty MLA
in the form and conditions of his detention is regulated by the Government of the Russian Federation;
is an agreement between the insured and the insurer - the medical insurance organization (SMO), whereby the latter undertakes to organize and finance the provision of citizens, subject to insurance, medical aid;
contains the names of the parties, duration, number of citizens to be insured, the procedure for providing and updating the list of people to be insured, as well as the procedures for payment of insurance premiums;
includes, as integral parts: (1) The territorial program of state guarantees the provision of the public entity of the Russian Federation free medical care to be approved in accordance with established procedure and determining the amount, quality and condition of providing medical assistance to the podlezhaschii insurance, (2) a mutually agreed list of health facilities providing medical care to citizens in local self-government;
rights, duties, responsibilities and other parties do not contradict the laws of the condition.
On January 1, 2011 came into force a new federal law on local self-government in Russia, according to which a May 1, 2011 introduced new rules of registration policies and introduced a policy OMC OMC single sample [3]. Those citizens who are the first such document, should contact their chosen medical insurance companies. First, the citizen is issued a "provisional certificate" attesting to registration policy, which is valid for 30 working days. During this time, citizens will be made for personal insurance policy. Once the document is ready, the insured be notified and exchanged him "interim certificate" on the policy. New policies OMC single sample will not have to change for dismissal, changing jobs or moving to a new place of residence. Replacement of old policies to new will be phased in over 2011-2013 period.[Edit] The rights of the insured
participation in all types of health insurance;
free choice of medical insurance organization;
control the conditions of the contract the MLA.
These rights of the insured defined above-mentioned law and in fact are declarative.
Since the right of the insured for compulsory medical insurance to participate in all kinds of health insurance means the only possibility of simultaneous participation in voluntary health insurance (VHI).
The right of certain categories of insured (executive body of the subject of the Russian Federation, local government, state, federal, municipal organizations, etc.) to free choice of insurers is limited to a requirement of the Federal Law of the tender to select one. The result is a tender, as a rule, substantially narrowed the list of one or two insurers.
In view of this statutory right is limited to the declared citizen to free choice of insurers, in particular the right to free choice of insurers all unemployed citizens. Finally, the right of the insured to control the conditions of the contract CBOs directly follows from the nature of the agreement of the parties - the insured and the insurer (QS).[Edit] Duties of the insured
registered as an insurer in the Territorial MHI Fund;
conclude the contract with OMI medical insurance organizations for citizens to be insured;
pay premiums in accordance with established procedure;
take measures to eliminate adverse impacts on the health of people (within its jurisdiction);
provide medical insurance organization information on indicators of health of citizens to be insured.
These duties also declared the above Act.
The obligation of the insured to register the Territorial MHI Fund - an independent non-profit financial institution that implements the state policy of local self-government, accumulating funds for CBOs and distributing them among insurers in sootvnetstvii with the need of people insured for health care - is the need to control and account payment of the insured in the entity of the Russian Federation.
The obligation of the insured to sign contracts with insurance OMC medical organizations for citizens to be insured, is his primary responsibility.
Obligations of the insured to take steps to eliminate the adverse impacts on the health of citizens and provide information to insurers on health outcomes of citizens to be insured, are declarative.[Edit] The responsibility of the insured
for breach of the duty to register as an insurer in the Territorial MHI Fund punishable by an administrative fine of five hundred to one thousand;
violating the laws of the Russian Federation on insurance premiums timing of the calculation of accrued and paid premiums to the organs of state budget funds, exercising control over the payment of insurance premiums, punishable by an administrative fine on officials in the amount of three hundred to five hundred rubles.
[Edit] Voluntary InsuranceQuestion book-4.svgThis section is missing references to information sources.Information must be verifiable, otherwise it can be questioned and removed.You can edit this article by adding references to authoritative sources.This mark is for the article in May 12, 2011
Voluntary health insurance is an additional program to set the volume of care that applies to the persons specified as insured beneficiaries. LCA is carried out by means of a specific budget, the personal contributions of the citizens, contributions by the employer.
It should be noted that the LCA does not insure health, but the cost of treatment, the latter usually reimbursed to the insured or on stage medical interventions (pharmaceuticals, diagnostics, hospital) or by type of care provided (dentistry, gynecology, cosmetics, accidental death), or shares the costs of reimbursement of medical care (full recovery, the percentage of compensation, the compensation to a specified amount).
Voluntary health insurance for individual decided to subdivide (taking into account the complexity of the particular disease specific individual) and collective (taking into account the risk of certain diseases among groups of individuals).
Under Russian law, safeguarding and protecting the rights of insured citizens are engaged in:
legislative body of the subject of the Russian Federation
executive authorities of Russian Federation
policyholders (employers)
Regional Health Insurance Fund (for the corresponding system)
medical insurance organizations and their associations
Body of Health Management
professional medical associations
health facilities (clinics, hospitals)
Licensing and Accreditation Commissions
state control (the prosecutor's office, the competition committee, the Commissioner for Human Rights, the Representative of the Russian President, Roszdravnadzor)
agents of social control (trade union bodies, the Society for Consumer Protection, the media, citizen)
subjects of pretrial and trial dispute resolution.
Paid medical services provided to citizens by medical institutions within the framework of contracts concluded in the form of preventive, diagnostic and treatment, rehabilitation, orthopedic and dental care.
For the activity in medical institutions must have their corresponding certificate and license. State and municipal health agencies provide paid medical services to people with special permission of the relevant body of health management.
Paid medical services are:
types of health care are not included in the list of government-guaranteed and subject of the Russian Federation;
medical services provided at the request of citizens, over the volume of established standards of care approved by the Ministry of Health and Social Development of the Russian Federation;
health services provided in a planned manner to citizens who are not entitled to them free of charge.
[Edit] Health insurance going abroad (travel)
This type of insurance is a voluntary form of insurance, but the availability of insurance policy for medical expenses traveling abroad (Exp) is a mandatory requirement for obtaining a visa in some countries (Schengen countries, etc.)
Discussions are under way to introduce this type of insurance in the number of mandatory, when you make a trip through a travel agency.
Specific insurance regulations of the insurance company determined the volume of services paid polysomes adults, but usually it is:
Medical services - treatment of acute illnesses or injuries arising
Medical and transportation services - delivery of the patient to the hospital, transportation from one hospital to another, if necessary - the evacuation of the patient's country of residence, with accompaniment.
Repatriation of remains
As a rule, according to the rules of insurance is not paid adult treatment:
Cancer
conditions associated with pregnancy and childbirth
psychiatric disorders and their consequences
injuries to the influence of alcohol or drugs
systemic connective tissue diseases
Solar allergies and sunstroke
diseases that occur during natural disasters - earthquakes, volcanic eruptions, tsunamis
For the organization of medical care overseas insurance companies attract company-Assistance.[Edit] See also
Law on Compulsory Health Insurance
The amount of insurance for tourists to be increased
[Edit] Notes
↑ The Federal Law of 29.11.2010 N 326-FZ (as amended on 06.14.2011) "Compulsory Health Insurance in the Russian Federation"
↑ territorial program of state guarantees the provision of Russian citizens free health care in St. Petersburg in 2012 (. Doc)
↑ The new law on local self-government shall enter into force on 1 January
[Edit] See also
Compulsory social insurance in Russia
Medical Law
Medical service
Federal Fund for Mandatory Health Insurance
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