A medical insurance policy is a document that certifies a concluded contract for medical insurance of a citizen of the Russian Federation. Health insurance may be compulsory (compulsory medical insurance) and voluntary (compulsory medical insurance). What is the difference between compulsory medical insurance from voluntary medical insurance? The contract of compulsory insurance is concluded between two legal entities - an organization, institution, enterprise and an 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 VHI, in addition to mandatory contributions to the MHI fund, contributions remain in the insurance company. VHI can be obtained by anyone on their own or through a company that pays these contributions from the payroll.
The compulsory insurance 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;
- listing of clinics, dentistry, high-pressure department, consultations to which the citizen is attached.
This medical insurance policy must be certified with the seal of the organization and the signature of the head, as well as contain the signature of a citizen. On the back of the policy, as a rule, information is indicated:
- phones of the insurer;
- her postal and email addresses;
- Phones of information pharmacies, hotline, claims and the department for the protection of the rights of insured.
Where to get a medical insurance policy must 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 independently, choosing a more reliable insurance company. The following services are included in an individual policy:
- ambulatory care;
- Ambulance;
- inpatient care (in hospitals);
- home help;
- diagnostics (ultrasound, medical examination);
- dental care (all services except prosthetics and cosmetology).
According to VHI, there are programs for adults and children.
Non-working population (pensioners, unemployed, children) also have the right to be insured under the compulsory medical insurance system. Earlier, these categories of citizens received an insurance medical policy from one insurance company, but now they can apply to any company.
Rights of citizens under compulsory medical insurance and obligations in accordance with Art. 16 of Law No. 326
A citizen who has received a medical insurance policy has the following rights:
- in case of an insured event, get free medical care in the Russian Federation;
- choose a medical institution, doctor, insurance company by submitting an application of the appropriate sample;
- to protect personal data through electronic processing;
- to compensation for damage caused by poor performance of medical duties or their non-performance.
Responsibilities of citizens:
- present a medical insurance policy in case of contacting doctors for help (except in emergency cases);
- when changing the insurance company, apply independently or through a representative;
- within 1 month to notify the insurer of the change of full name and place of residence;
- when changing your place of residence, be insured for a month.
All medical insurance innovations can be found by reading Law -326 (2010).