Information on OMS outpatient care. Information on compulsory medical insurance outpatient care Is it possible to apply for a compulsory medical insurance policy online

Moscow City Compulsory Fund health insurance established by the government of Moscow and the Moscow City Duma in 1993 to provide constitutional guarantees to residents of the metropolis to provide free medical care. The guarantor is the CHI policy.

Moscow City Compulsory Medical Insurance Fund: goals and objectives

Project goals:

• maximum efficiency of use financial resources fund;
• improving the quality of medical care offered to the population under the CHI program.

To solve the set tasks, the Fund has developed and approved special programs aimed at obtaining, processing, protecting, storing and transmitting information in the database.

Tasks of the Moscow City Compulsory Medical Insurance Fund

The duties of representatives of the Moscow State Medical and Social Insurance Fund working in the administrative districts of Moscow include:

• issuance control;
• identification of violations concerning the procedure for providing medical care in district clinics;
• monitoring the precise performance of functions by insurance companies medical organizations.

Are hospitals, clinics, insurance companies, as well as regional funds. The subjects include regional funds, insurers and citizens who have received the policy.

Territorial attachment to a polyclinic in Moscow according to MGFOMS

Muscovites have the legal right to independently choose any medical organization participating in the CHI program from the existing list. Before submitting an application for attachment to a primary care facility, the insured must:

• get acquainted with the list of doctors conducting appointments;
• find out the number of attached persons;
• get information about medical areas.

To attach, a citizen, or his representative, must come to the clinic and write an application according to the proposed sample. After verifying the data specified in the application, the clinic will notify the citizen of attachment. Attached persons can make an appointment with a doctor electronically.

If you want to change the clinic, you do not need to detach from the previous organization. The selected institution will do this on its own.

Change of health insurance company

After entry into force federal law on compulsory health insurance, insured citizens received the right to independently choose a medical institution for attachment. This is due to the transition of medical organizations operating in, to the per capita method of financing for outpatient services for the attached population.

People who are dissatisfied with the services of the company in which they are insured have the right to choose another organization from the list offered on the official website of the MGFOMS.

Citizens can change the organization:

• come of age, or fully capable;
• legal representatives of the child(parents and people with power of attorney) under a certain age.

You can only make a replacement once a year until November 1st. An exception is a move to another place of residence, or termination of the contract.

Getting a policy

Thanks to, citizens receive the necessary medical care free of charge. Electronic policies, which appeared in August 2015, replaced the previously issued plastic green cards and blue forms with information printed on them.

Every citizen has the right to replace the old document with a new one. electronic policy by contacting your medical organization with a statement.

OMS policy in Moscow

is a document that no one except the owner can use, which is due to the presence of a chip, personal signature and photograph of the insured. The document number is displayed on the front side. On the reverse side there is full information about the owner of the policy with his signature, as well as the validity period of the document.

To make an appointment with a specialist, a citizen with an electronic policy can use as a portal public services and electronic terminal. Old-style documents are considered valid until they are replaced with electronic ones. A person wishing to receive an electronic policy must write an application using a special form, collect a package required documents and apply to insurance company in which he received old policy.

Any form, issued to citizens free of charge and valid throughout the Russian Federation.

The set of documents attached to the application depends on the age and nationality of the person applying for the policy. WITH complete list documents required when applying can be found on the official website of the MGFOMS in a special section.

Policy check

Muscovites can, using online service, on the MGFOMS website. To do this, you need to know the document number. Usually, the need for verification arises when a citizen's employment status changes, or he is uncertain about the existence of the organization that issued the policy.

Information about the document that appears on the screen after entering the data indicates that the policy is valid. If the information could not be obtained, the insured person must contact insurance organization to create a new document.

The authenticity of the document can be established using the phone. By informing the policy number of the official representative, the citizen will receive the necessary information.

Checking by last name can be carried out by people who have forgotten the document number. To do this, you need to go to the MGFOMS website and fill out an online form by entering your full name and passport data, or full name, date of birth and address of residence. After that, the number of the current policy is displayed on the screen.

The procedure for protecting the rights of insured citizens

The protection of the rights of citizens insured in is fully entrusted by the Moscow government to insurance companies. The rights of insured citizens can be defended in court or during pre-trial proceedings. Insured citizens independently choose the way to protect their rights.

To do this, you need to make a complaint and send it to the following authorities:

• the head of a medical institution;
• the leadership of health care operating in the territory of the respective administrative district;
• city ​​health department;
• the organization that issued the policy;
• GAEK;

The City Arbitration Expert Commission accepts applications that were considered by the insurance organization without a positive result.

Complaint about OMS

Protection of the rights of the insured is carried out in several stages:

• acceptance and consideration of the complaint;
• examination of the quality of medical care provided;
• launching a mechanism for pre-trial conflict resolution;
• analysis of the obtained expert data;
• decision-making.

MGFOMS has launched an electronic service that will inform insured citizens in detail about medical care provided at the expense of compulsory medical insurance.

Using the website of the Moscow City Compulsory Medical Insurance Fund, you can get data on the cost, location and result of the examination. the main task service, to help the insured person correctly assess the availability and quality of medical care received.

Key Performance Indicators

The main activity of the fund is to ensure the protection of the rights of insured Muscovites, a method of improving the quality of medical care and its accessibility to all categories of the population.

The rights of insured citizens are protected in several areas:

• consideration of appeals and complaints of Muscovites, study of information, analysis and decision-making;
• monitoring the activities of the HMO in connection with complaints received;
• conducting expert events.

The basis for the adoption of certain decisions are the results of the fund's expert activities. The Foundation or the CMO are the organizers of the ECMP. The examination is carried out by doctors included in the register of experts. On the this moment the territorial directory lists 480 doctors, and more than 45 specializations. At the same time, MGFOMS provides multi-level quality control of examinations, which eliminates the occurrence of errors and incorrect conclusions.

Most often, the audit reveals violations related to the financial and economic activities of medical institutions: inconsistency of documentary data with the state of accounts, or discrepancies between paid invoices and the register.

Also, as a result of the examination, the following are revealed:

• violations admitted in the provision of medical care;
• poor patient care in the event of an insured event.

The Fund considers and satisfies all appeals and complaints of citizens.

Advantages of the electronic service for insured citizens

Every citizen can get any information of interest through a personal account created on electronic service MGFOMS. With the help of the data obtained, Muscovites can monitor the activities of the foundation, find out the conditions for providing free medical care, compare the work of a particular medical institution and the real cost of the services provided.

An insured citizen can enter his contact details, indicate the presence of chronic and past diseases, allergic reactions and other information that will be available to emergency doctors online. In the event of an emergency call, they will receive the necessary data on the way to the patient, and choose the most effective tactic for providing assistance.

With the help of the service, insured persons can independently attach to the clinic and information about the medical services provided.

Services under the MHI policy at the Moscow State Fund, video

Citizens insured in the MHI system and using the capabilities of the "Personal Account" can, based on the information received, objectively evaluate the activities of medical organizations, the quality and availability of services, and also monitor the fund's expenses. See also information about dental treatment under the CHI policy for free.

Policy Compulsory health insurance is a system that allows you to receive most medical services free of charge in any region. It works as follows: every month, everyone who works in the Russian Federation makes contributions to the Compulsory Medical Insurance Fund. These funds go to insurance medical organizations operating in the CHI system. And already they pay for the work of employees of polyclinics, hospitals, dispensaries and other medical organizations - according to the number of patients served and the services provided to them.

To give you medical services free of charge, you must confirm that you are in the CHI system. This can be done by presenting the CHI policy.

2. How to apply for an OMS policy?

To apply for an OMS policy, you will need:

• passport or temporary identity card if you are changing it;
• insurance number of an individual personal account (SNILS).

If you are taking out a policy for a child, you will need:

• application (to be completed at the reception);
• birth certificate of the child;
• a document confirming that you can represent the interests of the child: your passport, an act of the guardianship and guardianship authority on the appointment of a guardian or trustee, a court decision, and so on;
• SNILS of the child (for children under 14 years old - if available, for children over 14 years old - mandatory).

If the documents will be submitted by your representative, for registration you will additionally need:

• representative's passport or temporary identity card, if he changes it;
• power of attorney for insurance in the selected organization.

MHI policy can also be issued To apply for a CHI policy, a foreigner will need:

• application (to be completed at the reception);
• passport of a foreign citizen or other document recognized in Russian Federation proving the identity of a foreign citizen in accordance with an international treaty;
• a residence permit for permanent residents of Russia or a mark on a temporary residence permit in the Russian Federation in a foreign citizen's passport or other identification document for temporary residents of Russia;
• SNILS (if available).

You can submit documents to an insurance medical organization from the register of the Moscow City Compulsory Medical Insurance Fund. Citizens of the Russian Federation registered in Moscow (both adults and children) who have never previously received a CHI policy can apply for a policy both at an insurance company and at any center of public services, regardless of the area of ​​registration.

Please note: before the child's birth is registered and for 30 days thereafter, the child's health insurance is provided by the same insurance company that insured the child's mother or other legal representative. After this period, one of the parents or other legal representative may choose another insurance company for the child.

The compulsory medical insurance policy will be ready within 30 working days after the registration of the application and the documents submitted by you. At this time, on the day of the application, you will be given a temporary policy, which you can use as usual.

3. How to change or restore the CHI policy?

If you are satisfied with your insurance company, you need to change the CHI policy or issue a duplicate of it in cases where:

• you changed your place of residence, full name or other data in your identity document - within a month;
• you have discovered an inaccuracy in the personal data specified in the document;
• you have an old-style MHI policy (green sheet of A4 format or plastic card), and you want a new document (blue sheet of A5 format or three-color plastic card);
• you have damaged or lost the CHI policy.

To replace or obtain a duplicate policy, you will need the same documents as for initial clearance. If your personal data, place of residence has changed, or inaccuracies are found in the issued CHI policy, you will also need documents confirming this.

You need to contact your insurance company. V

If you want to change the insurer, you need to apply for a new policy in the organization you like. But pay attention to general rule You can change the insurance company no more than once a year. If you have changed your place of residence or your insurance company has ceased operations - as often as possible. At the same time, from November 1 to December 31, applications for changing the insurance company are not accepted.

Within 30 days after the registration of the application and documents submitted by you, you will be issued a CHI policy of a new sample (old-style policies are no longer issued). During this time, you will be given a temporary policy, which you can use as usual.

4. Can I apply for an OMS policy online?

Adult users of the Official website of the Mayor of Moscow, who have a complete (confirmed) account, which in personal account specified by SNILS.

To apply for (replace, restore) an MHI policy online, you will need:

• scanned copy of an identity document;
• Black and white photo 320x400 pixels, up to 5 MB in format: JPG, JPEG, JPE.">photo(when ordering a CHI policy in the form plastic card with electronic media)
• Scanned copy of the signature in black and white, size 160x736 pixels, up to 5 MB in size: JPG, JPEG, JPE. The size of a handwritten signature should not exceed 10x46 mm.">Scanned copy of the signature(when ordering a CHI policy in the form of a plastic card with an electronic carrier);
• CHI policy number (if any).

After you submit the documents, a temporary certificate will be available for you to download in your personal account. The CHI policy itself will be ready within 30 days after registration of the submitted documents. You can get it at the point of issue of policies of the medical insurance organization or at the center of public services (depending on which method of receipt you indicate when submitting documents).

5. How can I check if my CHI policy is valid?

6. What medical services can be obtained free of charge under the CHI policy?

Under the CHI policy throughout Russia (regardless of where it is issued), you can receive free Medical services are provided in medical organizations participating in the implementation of territorial CHI programs, in the amount established by basic program compulsory health insurance.

Contacts

Moscow City Compulsory Medical Insurance Fund
Foundation website (with the possibility of applying through the registration form):
http://www.mgfoms.ru/

Addresses and phones:

Moscow City CHI Fund
Address: 117152, Moscow, Zagorodnoe shosse, 18a
Department for Ensuring the Rights of the Insured: 952-93-21

City Arbitration Expert Commission (GAEK)
contact number: 952-93-21

Federal CHI fund
Address: 127994, Moscow, Novoslobodskaya st., 37
Phone: 8.499-49 3-44-55, fax: 8.499-49 3-49-30

Moscow Regional Compulsory Medical Insurance Fund
Address: 1 15114, Moscow, Derebenevskaya nab. , d.7, building 1
Phone: 2 23 - 71 - 36, ext. 11-73 (Department for the protection of the rights of the insured)

Department of Health of the City of Moscow
Duty - phone: 251-83-00 (round the clock)
Address: 1 27 006, Moscow, Oruzeiny lane, 43

Hot line Department of Health of the city of Moscow -
phone: 251-14-55,
opening hours: mon. – Fri. from 9:00 to 20:00, Sat. - Sun. - weekend

Hotline of the Department of Pharmacy of the Department of Health of the City of Moscow - phone: 623-46-36 (on weekdays)

Information about the availability of medicines and medical products in the city of Moscow - phone: 927-05-61,
opening hours: mon. – Fri. 09:00-20:00, Saturday 09:00-18:00, Sunday 10:00-16:00

The addresses and phone numbers of the health departments of the administrative districts of Moscow are on the foundation's website.

Some questions and answers on CHI in Moscow

Question:
I have repeatedly heard and read that the compulsory medical insurance policy gives the right to receive free medical care included in the Moscow city ​​program OMS. But how do you know if a particular medical service is included in this program?
Answer:
You should contact your insurer CHI insurance medical organization. Her address and phone number help desk is on your CHI policy.

Question:
I heard that in medical institutions that provide free medical services, paid ones can also be provided. Is it so? Could you tell us what these services are and what is the procedure for obtaining them?
Answer:
Yes, this is correct. Along with free medical services in the same medical institution in Moscow, services can also be provided for a fee. They can only be provided in those state and municipal medical institutions in Moscow that have licenses for the relevant types of medical activities and permission from the Moscow City Health Department to provide paid medical services. In this case, citizens must be provided with the following information:

* about the location of the institution (the place of its state registration);
* on the mode of operation of the institution, units and offices for the provision of paid and free medical care;
* about the types of paid medical services, indicating their prices;
* about the rights, duties, responsibilities of the patient and the medical institution;
* on the availability of a license for medical activities;
* about the benefits provided by the medical institution for certain categories citizens;
* about controlling organizations, their addresses, telephones.

The following may be provided for a fee:

* medical and service services with an increased level of comfort;
* hospitalization in specially allocated beds (in excess of the state order);
* treatment and examination for a concomitant disease in the absence of an exacerbation that does not affect the severity of the course of the underlying disease;
* examination, treatment, observation at home (except when the patient is unable to visit a medical institution due to health reasons and the nature of the disease or when home care is provided as part of the organization of hospitals at home);
* home care;
* anonymous medical services (except as provided by the legislation of the Russian Federation);
* medical services using permitted alternative technologies and methods of treatment, the costs of providing which are not included in the standard cost of treatment at the expense of the relevant budgets or MHI funds.

At the same time, certain medical services related to preventive, medical diagnostic, rehabilitation, prosthetic and orthopedic, and dental care can also be provided for a fee. Therefore, the medical institution must first inform the patient about the possibility of receiving the service free of charge and, in addition to the contract, obtain the written consent of the patient for a paid medical service. It must contain information that he is aware of the available alternative to receive free medical services and agrees to receive these services for a fee.

Previously, the patient must conclude an appropriate agreement with the medical institution. It can be concluded both orally and in writing. The oral form of the contract is provided in cases of immediate provision of services. Written proof of its provision is the patient's medical record with a list of services provided, cash receipt or blank strict accountability on payment for the service, the amount of which corresponds to the price list of services. Written form provided in cases of long-term nature of the service (services). At the same time, the contract should regulate the conditions and terms for receiving the service, the procedure for calculating, the rights, obligations and responsibilities of the parties.

It happens that the patient, having agreed to receive a paid service, after a while finds out that it could be provided to him free of charge, and asks to return the money spent to him from the CHI funds.

Therefore, in order not to become a hostage of such a situation, first find out the procedure and conditions for the provision of paid medical services in this institution, the possibility of obtaining them free of charge.

For clarification, you can also contact the insurance medical organization, where they will tell you whether such a service is included in the Moscow city compulsory medical insurance program.

Know that it is much easier to decide whether your treatment is free before you pay than to prove later that you did not pay voluntarily, but under duress!

Question:
We are Muscovites, we have CHI policies. Our daughter (she is 4 years old) was found to have serious disease heart, which requires expensive treatment. Our family is unable to pay for it. own funds. Can she get such medical care free of charge and how to do it?
Answer:
Expensive (high-tech) types of medical care are not included in the compulsory medical insurance program and are not financed from compulsory health insurance funds.

According to the Program state guarantees providing citizens of the Russian Federation with free medical care in 2007, high-tech medical care for citizens of Russia can be provided at the expense of federal budget, or funds from the budget of the constituent entity of the Russian Federation.

Regarding the organization of the free provision of expensive (high-tech) medical care to your daughter, we recommend that you contact the Moscow Department of Health, which is in charge of considering and resolving such issues, having with you all the necessary medical documentation of the child (Reception of the population: 2nd Schemilovsky per., 4-A, building 4 (Monday - Thursday from 09.00 to 18.00, Friday from 09.00 to 16.45, lunch from 13.30 to 14.30).

Your daughter's medical records will be reviewed, if necessary, she will be consulted by relevant specialists, after which a decision will be made to send her either to a federal clinic, where treatment will be carried out at the expense of the federal budget, or to a city medical institution where your daughter will be treated. organized at the expense of the budget of the city of Moscow.

Question:
How to be insured under compulsory medical insurance for citizens in case of refusal to receive medical care, charging for medical services that should be free, poor-quality medical care, where can one turn if such claims arise?
Answer:
The rights of citizens insured under MHI to receive free medical care are defined by the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens and the Law of the Russian Federation “On Medical Insurance of Citizens in the Russian Federation”.

If the rights of a patient who applied for medical care in the capital were violated, he can apply:

To a leader or another official medical institution;

To the health department of the corresponding administrative district of Moscow;

To the Department of Health of Moscow (Moscow, Oruzheiny per., 43);

* to the insurance medical organization that issued the compulsory medical insurance policy to the insured and, thus, assumed responsibility for protecting his rights;
* to the City Arbitration Expert Commission (GAEC) (in case the patient's claims have already been considered by the insurance medical organization and have not been satisfied. Applications for transfer to the GAEC are accepted by the Office of the CHI Organization of the Moscow City Compulsory Medical Insurance Fund, tel. 952-93-21) ;
* to court.

Question:
Whom can I turn to for assistance if the attending physician in the district clinic refuses to refer me for consultation and diagnostic tests to specialized medical institutions? I am a Muscovite, I have a compulsory medical insurance policy, and these medical services are included in the compulsory medical insurance program.
Answer:
You can contact the head of the department, the deputy chief physician for medical work, the head physician and, if the issue is not resolved in the polyclinic, to the health authorities of your administrative district (address and reference phones available at the clinic) and to the Moscow Department of Health (43, Oruzheiny per., Moscow, tel.

Question:
Tell me, what should I do if my 8-year-old daughter needs a specialist consultation, but the doctor of this profile in our children's clinic has now gone on a long vacation?
Answer:
In this case, the attending physician, who has appointed the patient a consultation with a specialist for medical reasons, is obliged to issue a referral to another medical institution operating in the compulsory medical insurance system, where your child will receive the required consultation free of charge. In case of difficulty in providing advice, we advise you to contact the head of the department, the head doctor of the polyclinic or his deputy, the health department of the administrative district (his phone number and address can be found in the registry of the polyclinic), as well as the medical insurance organization that issued the policy to your daughter.

Question:
What are the obligations of an insurance medical organization in relation to citizens insured by it under compulsory medical insurance?
Answer:
These obligations are defined by the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation". These include: conclusion of contracts with medical institutions for the provision of medical care to those insured under compulsory medical insurance; issuance of medical insurance policies; control of the volume, timing and quality of medical care and protection of the interests of the insured.

According to clause 6.8 of the Rules for Compulsory Medical Insurance of the Population of the City of Moscow, approved by Decree of the Government of Moscow dated 26.02.2002. No. 141-PP (as amended on November 25, 2003), a medical insurance organization is also obliged to familiarize citizens receiving a CHI policy with the current CHI program, the rights of the insured person to receive medical care, the obligations of the insurance medical organization and the medical institution in relation to the insured. If you have not been provided with such information, you can find it in the reference and information service of the HMO (the address and phone numbers are indicated on your CHI policy), at the policy issuing points in the clinic.
Based on the personal written requests of the insured HMOs, they carry out an examination of the quality of medical care provided under the Moscow City Compulsory Medical Insurance Program.

Question:
Who is eligible to receive a CHI policy in Moscow?
Answer:
In accordance with current Rules compulsory medical insurance of the population of the city of Moscow No. 141-PP, approved by the Decree of the Government of Moscow dated 26.02.2002. (as amended on November 25, 2003), policies in the capital are issued by insurance medical organizations to citizens of the Russian Federation, foreign citizens and stateless persons who have a place of residence in the city of Moscow; as well as citizens of the Russian Federation who do not have a place of residence in the city of Moscow, foreign citizens and stateless persons working at Moscow enterprises (or in their separate subdivisions in other territories of the Russian Federation) on the basis of relevant agreements.