WHAT YOU SHOULD KNOW ABOUT THE CHI PROGRAM?

(excerpts from the Federal Law of 29.11.2010 N 326-FZ

"On compulsory health insurance in the Russian Federation")

Basic concepts

• compulsory health insurance is a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in the cases established by this Federal Law within the framework of the basic compulsory health insurance program;
• the object of compulsory medical insurance is the insurance risk associated with the occurrence of an insured event;
• insurance risk - an anticipated event, upon the occurrence of which there is a need to incur expenses for payment of medical care provided to the insured person;
• insured event - an event that has occurred (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage for compulsory medical insurance;
• insurance coverage for compulsory medical insurance (hereinafter referred to as insurance coverage) - the fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization;
• insurance premiums for compulsory health insurance - compulsory payments that are paid by policyholders, have an impersonal nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;
• an insured person - an individual who is covered by compulsory medical insurance in accordance with this Federal Law;
• the basic program of compulsory medical insurance is an integral part of the program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to provide them free medical care at the expense of compulsory medical insurance funds throughout the Russian Federation and establishes uniform requirements for territorial compulsory medical insurance programs;
• The territorial compulsory health insurance program is an integral part of the territorial program of state guarantees for free provision of medical care to citizens, which determines the rights of insured persons to provide them with free medical care in the territory of a constituent entity of the Russian Federation and complies with the uniform requirements of the basic compulsory health insurance program.

Insured persons

Insured persons are citizens of the Russian Federation, foreign citizens permanently or temporarily residing in the Russian Federation, stateless persons (with the exception of highly qualified specialists and members of their families in accordance with Federal Law of July 25, 2002 N 115-FZ "On the legal status of foreign citizens in Russian Federation "), as well as persons entitled to medical assistance in accordance with the Federal Law" On Refugees ":

• working under an employment contract, including heads of organizations who are the only participants (founders), members of organizations, owners of their property, or a civil contract, the subject of which is the performance of work, the provision of services, under a copyright contract, as well as authors of works, receiving payments and other remuneration under agreements on the alienation of the exclusive right to works of science, literature, art, publishing licensing agreements, licensing agreements on granting the right to use a work of science, literature, art;
• self-supporting work (individual entrepreneurs, notaries in private practice, lawyers, arbitration managers);
• members of peasant (farmer) households;
• who are members of family (tribal) communities of the indigenous small-numbered peoples of the North, Siberia and the Far East of the Russian Federation, living in the regions of the North, Siberia and the Far East of the Russian Federation, engaged in traditional economic sectors;
• non-working citizens:

a) children from the day of birth until they reach the age of 18;

b) non-working pensioners, regardless of the grounds for granting a pension;

c) citizens studying full-time in educational institutions of primary vocational, secondary vocational and higher vocational education;

d) unemployed citizens registered in accordance with the employment legislation;

e) one of the parents or guardian who takes care of the child until the child reaches the age of three;

f) able-bodied citizens caring for disabled children, disabled people of group I, persons who have reached the age of 80;

g) other citizens who do not work under an employment contract and are not specified in subparagraphs "a" - "e" of this paragraph, with the exception of military personnel and persons equated to them in the organization of medical care.

Policyholders

1. The policyholders for working citizens specified in paragraphs 1-4 of Article 10 of this Federal Law are:

1.Persons making payments and other remuneration to individuals:

a) organizations;

b) individual entrepreneurs;

c) individuals who are not recognized as individual entrepreneurs;

• individual entrepreneurs in private practice, notaries, lawyers, arbitration managers.

(as amended by Federal Law of 30.11.2011 N 369-FZ)

2. Policyholders for non-working citizens specified in paragraph 5 of article

10 of this Federal Law are the executive bodies of the constituent entities of the Russian Federation, authorized by the supreme executive bodies of state power of the constituent entities of the Russian Federation, other organizations determined by the Government of the Russian Federation. These policyholders are payers of insurance premiums for compulsory health insurance of the non-working population.

Rights and obligations of insured persons

• free provision of medical care to them by medical organizations in the event of an insured event:
  a) throughout the territory of the Russian Federation in the amount established by the basic program of compulsory medical insurance;
  b) on the territory of the constituent entity of the Russian Federation in which the policy of compulsory medical insurance was issued, in the amount established by the territorial program of compulsory medical insurance;
• choosing an insurance medical organization by submitting an application in the manner prescribed by the rules of compulsory medical insurance;
• replacement of an insurance medical organization in which the insured citizen was previously, once during a calendar year no later than November 1, or more often in the event of a change of residence or termination of the contract on financial support of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance, by submitting an application to the newly selected medical insurance organization;
• selection of a medical organization from medical organizations participating in the implementation of the territorial compulsory health insurance program in accordance with the legislation of the Russian Federation;
• choosing a doctor by submitting an application in person or through his representative addressed to the head of a medical organization in accordance with the legislation of the Russian Federation;
• obtaining from the territorial fund, medical insurance organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care;
• protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance;
• reimbursement by an insurance medical organization of damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize the provision of medical care, in accordance with the legislation of the Russian Federation;
• reimbursement by a medical organization of damage caused in connection with its failure to fulfill or improper fulfillment of its obligations to organize and provide medical care, in accordance with the legislation of the Russian Federation;
• защиту прав и законных интересов в сфере обязательного медицинского страхования.
• The insured persons are obliged to:
• present a policy of compulsory medical insurance when applying for medical care, except for cases of emergency medical care;
• submit to an insurance medical organization, personally or through a representative, an application for choosing an insurance medical organization in accordance with the rules of compulsory medical insurance;
• notify the medical insurance organization about the change of the surname, name, patronymic, place of residence within one month from the day when these changes occurred;
• make a choice of an insurance medical organization at a new place of residence within one month in case of a change of residence and the absence of an insurance medical organization in which the citizen was previously insured.
• Compulsory medical insurance for children from the day of birth to the day of state registration of birth is carried out by an insurance medical organization in which their mothers or other legal representatives are insured. After the day of state registration of the child's birth and until he reaches the age of majority or after he acquires legal capacity in full and until he reaches the age of majority, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or another legal representative.
• The choice or replacement of an insurance medical organization is carried out by an insured person who has reached the age of majority or who acquired legal capacity in full before reaching the age of majority (for a child until he reaches the age of majority or after he acquires legal capacity in full until reaching the age of majority - by his parents or other legal representatives), by contacting the insurance a medical organization from among those included in the register of insurance medical organizations, which is posted on a mandatory basis by the territorial fund on its official website on the Internet and can be additionally published in other ways.
• To select or replace an insurance medical organization, the insured person personally or through his representative applies to an insurance medical organization of his choice with an application for choosing (replacing) this insurance medical organization. On the basis of this application, the insured person or his representative is issued by the insurance medical organization a policy of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance. If the insured person has not submitted an application for the choice (replacement) of an insurance medical organization, such a person is considered insured by the insurance medical organization with which he was previously insured, except for the cases provided for in paragraph 4 of part 2 of this article.
• Information about citizens who have not applied to an insurance medical organization for the issuance of compulsory medical insurance policies to them is sent monthly by the 10th day by the territorial fund to insurance medical organizations operating in the field of compulsory medical insurance in a constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them for the conclusion of contracts on the financial provision of compulsory health insurance. The ratio of working citizens and non-working citizens who have not applied to an insurance medical organization, which is reflected in the information sent to medical insurance organizations, should be equal.
• Medical insurance organizations:
• within three working days from the date of receipt of information from the territorial fund, inform the insured person in writing about the fact of insurance and the need to obtain a compulsory medical insurance policy;
• ensure the issuance of a compulsory medical insurance policy to the insured person in the manner prescribed by Article 46 of this Federal Law;
• provide the insured person with information about his rights and obligations.