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CHI insured persons are entitled to. Basic patient rights in the Russian Federation when applying for and receiving medical care

The compulsory health insurance policy provides access to free healthcare services. But does everyone know what opportunities the CHI policy provides, what is included in the free service, what types of examinations and operations can be performed?

Legislative acts regulating the CHI system

Free healthcare services are provided within the framework of compulsory health insurance. The CHI system guarantees citizens equal rights to receive medical services. It is regulated by a number of legal acts:

  • Law No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation";
  • Government Decree No. 1403 "On the program of state guarantees of free provision of medical care to citizens for 2017 and for the planning period of 2018 and 2019", which contains the basic compulsory medical insurance program. This document, in particular, explains what is included in the CHI in 2017;
  • a number of other acts that allow citizens to receive a minimum guaranteed volume of services.

Who is eligible for free medical care?

Both Russians (indefinitely) and stateless persons of the Russian Federation (with a limited validity period) can receive a compulsory medical insurance policy. The presence of this document means that the patient is under the protection of the insurance company with which he entered into an agreement.

Medical care is provided by a healthcare organization (both public and private institutions participate in the CHI system), to which the patient is attached. At the same time, he has the right to change the clinic and the attending physician once a year and an unlimited number of times - when moving to another place of residence. Once a year, it is allowed to change the insurer, this must be done no later than November 1.


List of services under the CHI policy

What types of medical care are available under the policy, does it include high-tech diagnostic methods, is MRI included in the list of free compulsory medical insurance services?
The legislation provides for the following forms of medical assistance:

  • emergency (ambulance);
  • outpatient, including examinations (the basic list includes MRI, ultrasound and endoscopic methods (gastroscopy, colonoscopy, etc.);
  • stationary:

- in cases of exacerbation of diseases;
– in the direction of treatment and operations (among the available services are chemotherapy, removal of prostate adenoma, treatment of diseases in gynecology, etc.);
– medical services for pregnant women, as well as childbirth, recovery after them, abortions;
- when intensive care is required (for poisoning, severe injuries);

  • high-tech;
  • palliative.

The last item on severe illness was added in 2017. In total, the basic list includes about 20 cases for which free medical care is available.

Is it allowed to carry out therapeutic massage, remove papillomas, warts - does the CHI policy provide such procedures, what is included in the program? To take a massage course free of charge will allow the presence of indications for the procedure. As for skin defects, the operation will be performed free of charge if the growth bleeds or is damaged, that is, there is a danger to the life and health of the patient.

Within the framework of the CHI system, there are basic and territorial programs: the first is applied throughout the country, the rest - within a particular subject of the Russian Federation. The list of services for regional programs is wider. Some of them provide free tests for chlamydia and spermogram, some allergy tests (such types of examinations, for example, are carried out under the MHI policy in Moscow, in the Moscow region and in St. Petersburg).

From time to time, the media report on public initiatives to add or remove this or that service from the list. For example, earlier proposals were discussed to exclude abortions from the mandatory health insurance system and include the work of a nutritionist in it, but they were not reflected in legislative acts.


Dental services under the MHI policy

Is free dentistry available under the CHI policy? This question is of interest to many, since the services of dentists, as you know, are not cheap. So, what opportunities does dentistry provide under the CHI policy, what is included in the free service?
A visitor to a clinic participating in the CHI system can expect:

  • for admission, examination and consultation;
  • for the prevention and treatment of inflammation of the oral cavity;
  • for filling teeth;
  • for surgical intervention (tooth extraction, opening of an abscess, etc.);
  • for x-ray examination.

It should be remembered that there are also restrictions on the services of dentists. For example, filling will not require payment of a fee if a cement material is used during the treatment. But a light seal will not be installed for free.

Separate services are possible with a referral, for example, the surgeon will perform the cutting of the frenulum of the tongue upon presentation of a certificate from the orthodontist.

How can I find out if a service is included in the CHI program?

Information on services provided free of charge is contained in the regulatory documents adopted in a particular subject. A detailed list is also provided by health care institutions and insurance companies operating in the CHI system.
There is no list of compulsory health insurance services on the official website of health care in 2018, but from the resource of the Ministry of Health, you can go to the website of the Compulsory Medical Insurance Fund, where all the regulations relating to the compulsory health insurance system are posted.

Announcement. Compulsory health insurance in the Russian Federation in 2020. Design features and necessary knowledge.

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Many citizens have already appreciated the value of compulsory health insurance. That is why he does not save on his health and actively pays for the pole.

So what is compulsory health insurance in Russia? And what are the main nuances of this procedure?

What you need to know

In accordance with the law, all citizens included in the system are entitled to receive free medical care throughout the Russian Federation.

How is the organization and financing of the fund

The Compulsory Medical Insurance Fund is an independent state credit company that implements state policy in the medical industry.

Such organizations are designed to accumulate insurance premiums, as well as ensure financial stability.

This is already regulated by an additional agreement on the part of the medical institution and the applicant.

In the clauses of the contract, you need to display:

  • date of conclusion;
  • the name of the insurer;
  • basis for activity;
  • subject of the contract;
  • volume of medical care;
  • date and signature.

Required documents

For registration you will need:

  • passport of a citizen of Russia;
  • birth certificate, if it is a minor citizen;
  • statement of the established form.

For refugees, you must provide an additional certificate of recognition as such. A foreigner must provide a residence permit or a passport.

Stateless persons must provide registration and passport details.

Calculation procedure

How to calculate compulsory health insurance, according to the Federal Law, payment for medical care is carried out after the medical organization provides a register of accounts and an invoice for payment within the established limit.

Insurance Company:

  • submits to the territorial body an application for receiving a target remuneration with an advance payment;
  • apply for a refund for services rendered.

Then the territorial body considers the application and satisfies it, transferring the required amount.

Detailed information about insurance premiums for compulsory health insurance (CHI)

The duration of the billing period is determined for each year of hours worked. This is how accounting works.

The duration of the provision of the service is the entire life of the insured person. Paying insurance premiums - an individual or an employer.

If a person is not employed, then he can independently contribute money to the FSS. Insurance premiums are credited to the federal fund.

Polis ( CHI) are given to a child shortly after birth, and to adults on. It is required to be presented when contacting any clinic or hospital, when children enter kindergarten and school. It would seem that why we need a medical policy and what rights obligatory health insurance gives us should be well known to all of us for a long time, but in fact, many people still have a lot of questions and not everyone clearly knows how to use CHI correctly?

The constitution guarantees us the opportunity to be treated for free However, in practice this is very difficult to do. Even with treatment in state clinics, we increasingly have to fork out, although experts say that it is real to get free treatment, and each of us can contribute to improving the quality of medical care received if we behave correctly.

Policy compulsory health insurance (CHI) is a document that gives us the right to receive free medical care throughout the Russian Federation. They issue a policy not only to adults, but also to children, and even newborns. Today, policies of the 2011 model are valid, and policies issued before December 31, 2010 are considered obsolete and are subject to replacement with policies of a new model. No one canceled the action of the "old" policies, they can be used, but they are gradually being replaced with new ones.

By law, each of us has the right to choose health insurance company. To do this, you need to find out which insurance organizations are available in the region where you live, compare the conditions for their services, opt for the best one, come to their office and write an application. The insurance organization must issue a temporary certificate immediately, on the day of application. The temporary policy is valid until the receipt of the permanent policy, which is usually issued within 30 days of receipt of the application.

Compulsory health insurance policy gives us the right to use free healthcare under the basic program of state guarantees. More specifically, OMS provides us with the opportunity to:
1. Upon the occurrence of an insured event, receive free medical care in full and of proper quality.
2. In case of harm to health during the provision of medical care, compensate for all damages.
3. Protect our rights and interests.
4. To gain a foothold in the medical organization that we choose ourselves.
5. Select a general practitioner, gynecologist, dentist and other medical specialists, subject to their consent.

If you have a policy CHI you can get medical care at the place of residence or temporary residence in those clinics and hospitals that operate under the compulsory health insurance program. The list of such medical organizations is posted on the official website of the territorial office of the Compulsory Medical Insurance Fund. A CHI policy issued in one region is valid throughout Russia.

If you received compulsory medical insurance policy at work and did not write an application, then attachment to the clinic occurs automatically at the place of registration, or at the address that you named when you received the policy. In the event that you have chosen another clinic and wrote an application, you will be provided with medical care in this clinic, but you will no longer be able to call a doctor home. At the same time, it is important to know: anyone can call an ambulance, you don’t need a CHI policy for this! Emergency medical care in our country should be provided regardless of the availability of the CHI policy and other documents.


Insurance medical organization, which issued the CHI policy, guarantees not only the provision of free medical care, but is also obliged to help in cases where there are difficulties in obtaining medical care. For example, when they do not give a coupon for a free examination; it is difficult to get to a specialist for an appointment; there are complaints about the quality of treatment; do not start treatment without payment.

If in public medical institution will offer to pay for treatment or examination, do not rush to go to the cashier. First, call your insurance company and ask if the service offered to you is among the free ones. Even if you have already paid for the treatment, keep the documents and receipt confirming the payment. Show them to the employees of your insurance company and perhaps they will help you get the money spent on treatment back.

By compulsory health insurance provides for the provision of medical care according to programs established by the state, while each subject has its own list. It is not comprehensive and high-tech operations cannot be carried out on it, since they are expensive and are not included in the program under such a policy.

Since 2010, the rules for providing free health care services for people with an insurance policy have changed. Now everyone is provided with a document with an unlimited validity period - a CHI policy. Let's take a closer look at what kind of document it is, to whom it is provided, and what services are provided by healthcare institutions upon presentation of this policy by the patient.

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What is a medical insurance policy

Until 2010, citizens' health insurance was provided for one year, then the policy had to be renewed. In the absence of such a document, the medical institution could refuse free treatment to the patient. Moreover, the employer was obliged to conclude an agreement with the insured company, for the unemployed - the employment service, and for minors - educational institutions.

After the release of the law regulating this aspect of relations, the rules have changed. Now every citizen can individually choose an insurer and receive a compulsory medical insurance policy from the company. Therefore, the competitiveness of insurance companies has increased, as well as their control over healthcare institutions has increased, because the quality of service has begun to play a large role in the number of attracted customers.

The compulsory medical insurance policy has now become indefinite, it does not need to be changed every year, because the contract with the insured is concluded for life. If the policy is lost, you can always contact the office of the company serving this patient and get a duplicate of it.

When applying to the hospital, the patient is required to present a document confirming the person's participation in the CHI insurance program. The basic services provided for this program are approved by the regional government each year.

Who is eligible to receive a CHI policy

Absolutely everyone has the right to provide this document. It does not matter where the person is registered, where his place of residence is, what is the age and social status of the insured. Basic services are provided free of charge to every person who visits the hospital and presents a policy.

It turns out that the following can receive the CHI document:

  • Any adult citizen of Russia.
  • Young children under the age of fourteen.
  • A person holding a refugee certificate.
  • A person with foreign citizenship who has permanent or temporary registration in our country.
  • Person without any citizenship.
  • A person without a permanent place of residence.

No insurer can refuse a person to participate in the MHI program due to lack of registration, citizenship or a certain place of residence.

Legal rationale

This aspect of relations is regulated primarily by the Federal Law, which was issued on November 29, 2010. This law No. 326-FZ is called "On Compulsory Medical Insurance in the Russian Federation." According to him, universal health insurance in Russia is designed to guarantee the protection of life and health of people. At the same time, stateless persons and refugees are equalized in rights with the rest of the inhabitants of our state.

The policyholder can get basic medical services without paying a fee. He can choose the insured himself, and if the patient is not satisfied with the quality of service, then once a year he can change it.

After the release of this law, the Duma issued several more acts that amend the current bill. The last amendment came into effect on January 1 of the current year (Law No. 418-FZ).

What you need to participate in the insurance program

Getting a document confirming participation in the health insurance program is very simple. It is enough to choose the right insurer and contact the office of their company.

There you will be offered to write an application, and will also be asked to provide documents:

  • For an adult resident of the Russian Federation - an identity card (passport).
  • For a minor child - a birth certificate, a passport of one of the representatives (parent, guardian).
  • For refugees, a refugee certificate.
  • For foreigners - an identity card, a residence permit or a temporary residence permit in Russia.
  • For those who do not have citizenship at all - an identity card, a mark on a permit for permanent or temporary residence (or a residence permit).

In addition, if you have a SNILS plastic card, you also need to provide it. When submitting the above documents, any of these categories of persons can enter the CHI program. The only reason for the policyholder's refusal to issue a policy may be the lack of necessary documents.

What else you need to know about the CHI policy

Thus, the presence of a certificate of a participant in the compulsory medical insurance program provides a person with free assistance in case of emergency, in case of deterioration of his health and a threat to life. Of course, no hospital will work for free. Who pays for the treatment of insured persons?

Contributions to the compulsory medical insurance system come from employers and from the budget for people who do not have official employment. This value is equal to 3.6% of the unified social tax.

It is important to know which services are included in the free CHI program. There are frequent cases of disputes when medical institutions refuse to provide assistance, because the case is not insured.

So, free insurance includes:

  • Emergency medical assistance.
  • Diagnosis and medical care at home and in hospitals, while outpatient treatment is not provided with drugs.
  • Inpatient stay in the following situations:
    • acute diseases or exacerbation of chronic diseases that require constant monitoring and control by a doctor;
    • epidemic diseases requiring isolation of the patient;
    • childbirth, abortion, fetal pathology;
    • acute poisoning;
    • serious injury;
    • rehabilitation after an illness requiring constant medical supervision.

The law does not provide for the provision of free of charge to patients the following services not included in the insurance program:

  • Outpatient examinations, consultations, diagnostics.
  • Special conditions for inpatient treatment of a patient (for example, a ward with an increased level of comfort).
  • Treatment in a sanatorium or resorts.
  • Services for anonymous citizens (does not include AIDS diagnostics).
  • Cosmetic services.
  • Dental prosthetics.
  • Preventive treatment of diseases during remission.
  • Non-routine vaccines and vaccinations.
  • Sexological pathologies.

The list of services provided free of charge is approved at the regional level, in individual subjects of the Russian Federation they may differ. You can find out this list at the local CHI department or by calling the phone number indicated on the policy itself.


The rights of the patient of the Federal Law 323 article "On the basics of protecting the health of citizens" are expressed in the provision of free medical care in any specialized institution of the country, subject to the provision of a compulsory medical insurance policy. The only exceptions are private organizations and services provided on a paid basis.

Rights and obligations of the patient

Each patient must clearly know their rights and obligations. This will help avoid disputes and protect your interests.

The patient's duties include strict adherence to the prescribed treatment method (with consent to it), reliable informing the doctors about the state of health and the appearance of signs of the disease in order to make the correct diagnosis. The patient is also obliged to communicate with the medical staff with restraint and conciseness, without raising his voice and becoming personal.

The list of patient rights includes:

  • Free provision of medical care.
  • Respectful and humane attitude from medical workers.
  • The choice of the attending physician and medical institution.
  • Conducting meetings and consultations.
  • Get accurate information about your health.
  • Consent or, inpatient treatment.
  • Compensation for damages due to improper treatment or negligence of the attending physician.
  • Obtaining free legal assistance in case of going to court to resolve medical disputes.

The above rights apply to any patients, regardless of the place of their treatment (public clinic, private hospital). Below we propose to consider the most significant rights of citizens in more detail.

Right to free medical care

Citizens of the Russian Federation have the right to receive free assistance in any municipal or state medical institution under the CHI policy. In the absence of it, it is possible to provide free emergency assistance.

Here it is necessary to understand that doctors do not have the right to refuse a citizen if they feel unwell, they are obliged to provide first aid, regardless of the availability of a policy.

Within the framework of free medical treatment, various types of assistance are provided:

  • preventive;
  • health-improving;
  • denture;
  • gynecological;
  • dental;
  • rehabilitation;
  • medical and diagnostic.

The patient also has the right to apply for free help in some private clinics., subject to the provision of a medical policy. You can find out which institutions this right applies to by calling the insurance company or by looking at the register of the same name.

The compulsory medical insurance policy is issued free of charge to all citizens of the Russian Federation immediately after birth. Refugees and foreign citizens residing in the Russian Federation on temporary registration also have the right to receive it.

The policy is issued on an indefinite basis. However, if a citizen of another country leaves the Russian Federation, the document is terminated ahead of schedule.

What types of medical care can be obtained free of charge?

The health insurance system provides for basic and territorial programs. They apply to all residents of the country, while directly dependent on the nature of the disease or the need for a preventive examination.

The basic program allows you to receive free medical care in any corner of the Russian Federation, regardless of permanent residence or registration of citizens. So, if a person goes on vacation or on a business trip to another city, he has the right to contact any clinic for free assistance. They cannot legally refuse him.

The basic program provides for the provision of emergency, primary and specialized medical care. Thus, a citizen has the right to call an ambulance, apply to a medical institution for a diagnosis, treatment and other purposes.

Territorial programs operate exclusively on the territory of the region that issued the policy. They include a wide range of medical services.

If we talk in more detail about the types of medical care, citizens have the right to turn to any specialist free of charge: a therapist, ophthalmologist, neuropathologist, gynecologist, pediatrician and others. The reverse situation is when there is no necessary doctor in the city (village). In this case, the patient is referred to a regional or district clinic.

The right to receive reliable information about the diagnosis

When applying for medical assistance, a citizen has the right to learn full information about his state of health, including:

  • diagnosis;
  • test results;
  • the chosen method of treatment;
  • list of prescribed medications;
  • treatment results.

This information must be provided by the attending physician. He does not have the right to hide any facts, to disclose knowingly false information, to deceive. Even when making an incurable diagnosis, the physician is obliged to notify the patient, regardless of the complexity of the situation and the requests of relatives.

  • disabled persons;
  • minor children;
  • drug addicts.

Obtaining information about the diagnosis is not the responsibility of the patient. This means that the doctor may be prohibited from disclosing it. A variant of obtaining information by the official representative of the patient (relatives) is possible.

Separately, it is worth noting the need to maintain medical secrecy. The physician cannot transfer information about the diagnosis or treatment method to an outsider. This will result in the imposition of an administrative or disciplinary penalty.

Right to damages

Unfortunately, in domestic medicine, medical errors are quite common. The patient or his relatives have the right to demand compensation for moral and material damage in court, in the event of:

  • causing harm to the health of the patient, due to the appointment of inappropriate treatment;
  • lethal outcome, subject to evidence of the guilt of physicians.

Such cases also include unqualified or untimely provision of assistance, negligence and other actions, the result of which negatively affected the patient's condition.

You can claim damages from a doctor or medical institution. This is purely individual, depending on the factors that led to harm to health.

The right to refuse hospitalization and surgery

Citizens have the right to make their own decisions. No one can force a patient to go to the hospital under duress. The task of a physician is to make a correct diagnosis and prescribe treatment, if his prerequisite is a stay in a hospital, he is obliged to convey to the patient the seriousness of the situation and explain the possible occurrence of complications.

A refusal can be written for any medical institution, this applies to the departments of pediatrics, gynecology, maternity hospital, therapy, surgery and others. The prescribed treatment should be carried out by the patient at home.

The only exception to the refusal is the provision of emergency assistance. It is also worth considering that the responsibility for minor children and incapacitated persons lies with official representatives. If the doctor sees an inappropriate attitude towards the patient, or considers hospitalization essential, he can convene a council to take coercive measures.

This mainly concerns minor children whose parents, for religious reasons, do not allow medical measures aimed at cure.

The patient has the right to refuse surgical intervention. However, in practice it can cost lives. Also, as in the case of refusing hospitalization, the doctor can convene a council or take advantage of an emergency.

Respectful attitude from medical workers


The right to respectful and humane treatment is one of the most important for patients. It was not in vain that it was singled out separately. Unfortunately, not all medical workers, including middle and junior staff, behave with patients with dignity.

A citizen must be completely sure that he will not only be provided with qualified medical care, but also treated with respect. Threats, rudeness, boorish expressions should not be heard from doctors and other personnel. Even a slight increase in voice is prohibited.

The inappropriate behavior of health workers is often justified by the low level of wages. However, the patient is not to blame for the financial difficulties of the attending physician or his nurse. Any rudeness may result in disciplinary action.

The patient has the right to file a corresponding complaint directly with the management of the clinic, which is obliged to punish the guilty person. As a rule, the physician is deprived of incentives or part of the salary is withdrawn as a fine.

The choice of the attending physician and medical institution

The introduction of the CHI policy made it possible for patients to choose their own doctor and medical institution free of charge. A citizen can write a statement refusing the services of a pediatrician or therapist, asking to be sent to the site to another specialist. The same goes for other doctors.

For example, a woman expressed a desire to register for pregnancy with a gynecologist attached to another district. She argued her request with her previous positive experience of contacting this specialist.

Despite the fact that the change of doctor is allowed by law, here you can encounter an ambiguous situation. It concerns the call of a specialist at home. This question should be discussed with the doctor in advance. Here it is worth understanding that all areas are divided into sections, to which certain doctors are attached. A specialist from another site is unlikely to come to the call, except perhaps on a paid basis.

Changing the attending physician, as a rule, requires a direct appeal to the head of the clinic. It is he who gives the appropriate permission, and also accepts applications from citizens.

The choice of a medical institution may be limited by the conditions of territorial programs. In this regard, it is worthwhile to find out in advance information about the clinic and the possibility of servicing it free of charge under the policy.

Protection of the rights of patients

Violation of the rights of the patient causes a lot of controversy. Each situation has its own characteristics and consequences. For example, someone is ready to go to court with complaints about the boorish attitude of a doctor, and someone calls the hotline in case of improper treatment.

To resolve issues, the patient must contact the Ministry of Health. All accepted complaints, including electronic versions, are redirected to the administration of the medical institution for further resolution. In addition, you can write a complaint:

  • directly to the head physician or head of the clinic;
  • to the city administration;
  • prosecutor's office or police;
  • territorial branch of the insurance company;
  • Rospotrebnadzor or Roszdravnadzor.

Before filing any complaint, it is worth visiting a qualified lawyer. He will help to understand the essence of the problem, justify it from a legal point of view and help draft the text of the document.

The result of the complaint may be the award of material or moral compensation, the imposition of disciplinary punishment, administrative fines, deprivation of the right to provide medical activities, deprivation or restriction of liberty.

The severity of the punishment depends solely on the amount of damage caused to the patient and the violation of his rights. In case of defamation, a doctor or medical institution may file a counterclaim against a negligent patient, which will entail administrative or criminal liability.

Patient rights: summarizing

The rights of patients are prescribed in the current legislation of the Russian Federation. Their violation leads to the punishment of medical personnel: administrative, disciplinary, criminal.

A citizen has the right to receive qualified medical, health-improving or preventive procedures free of charge. The patient has the right to choose the attending physician, medical institution, write a refusal of surgical intervention or hospitalization.

The duty of a visitor to a clinic or any other medical institution is to provide a compulsory medical insurance policy. It is issued immediately after the birth of a child or a person's registration of citizenship of the Russian Federation. The policy gives the right to receive free medical services not only in public, but also in some private clinics.

In case of violation of rights, the patient or his representative may file a complaint with a higher authority.

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