The presence of a compulsory medical insurance policy is a prerequisite for the provision of qualified and free assistance to citizens in polyclinics. To make an appointment with a doctor, the registry previously required a paper document. Global digitalization has made it possible to simplify access to medical services. From December 1, 2022, citizens can apply for an electronic CHI policy, which is considered an analogue of a paper one. But questions remain about what a “virtual” document is, how to get it, and whether they can not be accepted at the clinic if the Internet is not available and the patient cannot technically provide an e-policy. Let’s consider them in more detail.
What is the e-format of the CHI policy
A “virtual” MHI policy is an account in the unified register of those who are insured in the compulsory health insurance system. To get a ticket to the doctor, the owner of the electronic version is enough to provide a passport (birth certificate) or show a barcode from the display of a mobile phone. E-format minimizes bureaucratic red tape and makes access to medical services easier. The MHI policy in electronic form does not abolish the paper version, which continues to be valid and does not require replacement. Since the innovation is only being introduced into everyday practice, technical failures and the “human” factor cannot be ruled out. Therefore, for the time being, it is still recommended to carry a paper document with you.
A new sample document is a regular barcode that can be printed or shown from a smartphone screen. Do not forget that the scope of the patient’s rights is the same regardless of whether an electronic or paper MHI policy is issued to him.
Where to apply
An e-document can be issued at the MFC or on the Gosuslugi website. If a paper document is lost, the applicant has the right to contact the insurance company and receive an extract from the register with a barcode. Insurance companies can also issue e-policies.
How to get an electronic compulsory medical insurance policy
To apply, you will need an application with the following attached to it:
- civil passport (birth certificate);
- parents’ passports – if the document is issued for a minor.
There is no fee for issuing an electronic CHI policy (this rule applies to citizens of the Russian Federation). Newborns are automatically assigned a barcode in the CHI system.
Foreigners, in order to receive a “virtual” document in the health insurance system, must provide a passport of the country of which they are citizens, as well as a residence permit and SNILS (if any).
After submitting the documents, the interested person is issued a temporary policy valid for 30 to 45 calendar days. As an attachment, the applicant receives a leaflet containing the rules of use and a list of medical services provided free of charge upon presentation of a policy with a limited validity period. After 1–1.5 months, the applicant is issued an e-document, which is of an unlimited nature.
Additionally, the insured person receives a PIN code, which can be used to make changes to personal data.
How to get a compulsory medical insurance policy through the website of the State Service
You can issue a “virtual” document without leaving your home. This preference is available to users of the Gosuslugi portal with a verified profile. Using the reference and information platform is simple and convenient, since all customer data is entered by default (automatically), although the risk of technical errors cannot be ruled out. To make a policy on “Public Services”, it is enough to adhere to the following algorithm of actions:
- We select the option “Management of the CHI policy” (tab “Health”).
- We press the “Start” button and select the future owner of the document (“Me” or “Child”).
After that, the system will generate a request for a policy and no later than one working day, its number will be integrated into the user’s personal account.
Information such as the number, contacts of the insurance company, territorial affiliation to the clinic will always be available in the personal account. If necessary, at the “Gosuslugi” at any time you can change the region of insurance, suspend the insurance or resume it.
How to use the OMS e-policy
The “virtual” compulsory medical insurance policy is freely presented in all regions of Russia. The document gives the right to receive medical care free of charge, regardless of the geographical location (within the country) of its owner. Since the data of the electronic compulsory medical insurance policy is stored on the Internet portal “Gosuslugi”, its users can at any time go to the personal account and find out the policy number. To make an appointment with a doctor, it is enough to present a barcode or an extract from the register of insured persons, which can be downloaded on the website of the insurance company, to the receptionist.
Advantages of e-policy
Despite the identity of the legal force of the paper and electronic CHI policies, the second format is considered more preferable, because such a policy cannot be lost or damaged (all information is available on the State Services website). Since the fact of ownership can be confirmed with a barcode from a mobile phone, if you have a gadget, it is not necessary to take a paper policy with you.
Right to change insurer
If a citizen is not satisfied with the quality of the company’s work in the health insurance system, he can choose another counterparty.
“The main priority for insurers is to ensure the rights of patients and access to free and high-quality treatment within the framework of the state guarantees program. Representatives of companies are obliged to assist citizens at all stages of the provision of medical services,” says Natalya Grishina (expert of the Council for Medical Insurance of the All-Russian Union of Insurers).
Institutions involved in the health insurance system must deal with every violation of rights in polyclinics. If the patient suspects that he has been treated unfairly, he has the right to contact the insurance company.
When applying for an e-policy in the system of compulsory medical insurance, the interested person is given the right to choose a counterparty company. The corresponding application is submitted in parallel with the application form for inclusion in the unified register of insured clients. If a person has not decided on the choice of an insurance company, this function will be performed by the territorial CHI fund. A citizen can, on his own initiative, change the insurer no more than once during the year. This option is provided on the portal “Gosuslugi”. When you change your place of residence, you can change the region of insurance.
List of services provided
Medical examination at home, outpatient treatment, hospitalization, making an appointment with specialists – these and other services are available to the owners of a virtual document in the compulsory health insurance system. It grants the right to:
- diagnostic procedures and high-quality treatment of various diseases;
- call an ambulance;
- receiving dental services;
- pregnancy management;
- receiving palliative care (for terminally ill patients).
Persons insured in the compulsory health insurance system may also be provided with medications free of charge (if such a condition is provided for in the program). The list of services may be narrowed or expanded depending on the region. Detailed information on what types of assistance an e-CHI owner can count on can be obtained from the insurer or the TFOMS of a constituent entity of the Russian Federation.
As a result of the digitalization of the industry, insurance companies will be able to interact closely with insured customers. A new obligation of insurers will be the formation of an individual history for each citizen (the chronology of requests for medical help). From 2024, citizens will be exempted from the need to notify the insurance company in the event of a change in personal information (information will be automatically updated in the register).