Insurance is valid in many areas of a person’s life. Often this service has to be issued for the safety of life and health. A person will need an insurance medical organization, in which it will be necessary to draw up a contract. In the event of an insured event, the company undertakes to pay compensation.
The functions of an insurance medical organization are performed on the basis of a contract, as well as payment for services under compulsory medical insurance. Their activities do not take into account standard insurance contracts. Firms carry out only some of the work of insurers in compulsory medical insurance.
Rights
Companies operate on the basis of legislation. They also establish the rights of insurance medical organizations. Companies work for receiving a monetary reward for the services rendered. Their activities are carried out at specific rates, which are also approved by law.
Firms have the right to appeal the conclusion of a medical institution to assess the terms, conditions and quality of services. They can choose the institutions of a particular industry that will carry out the assistance. Insurance companies are involved in the accreditation of such institutions.
An insurance medical organization has the right to establish and regulate the amount of a voluntary contribution. They independently approve tariffs for services. The company may sue institutions if they have caused damage to the insured person.
Responsibilities
There are not only rights, but also obligations of an insurance medical organization. Employees of the company provide free assistance to their customers. By law, they must keep records of the services performed. They have an obligation to timely transfer to the SMO and the fund information about the insured person and the assistance provided.
The medical insurance company transmits reports on its work. Received funds can be spent only for their intended purpose. The company’s activities include the creation and improvement of a system of rules by which services will be provided. On their website, employees publish reliable information on the work schedule, types of services and other issues.
The activities of insurance medical organizations are aimed at providing compensation to clients in the event of insured events. After providing the policy, it is necessary to familiarize the person with his rights, obligations and risks. Within 14 days it is supposed to consider complaints, after which a decision is made.
The company provides customers with information about the work schedule, types of services, availability, quality. Mandatory activity is to send the contract compliance report to the fund. Employees of the organization represent clients in litigation.
Medical insurance organizations and institutions transmit information to the fund on changing customer data within 14 days. Employees issue policies no later than 5 days after consideration of the application. Firms protect the rights of insured persons. They return funds to customers, if provided for in the contract. Companies conclude deals on the implementation of medical assistance to citizens on the basis of VHI.
Other functions
An insurance medical organization also performs additional functions. It provides guarantees to vulnerable groups. Employees are involved in improving medical practices. They provide financial assistance to medical organizations that have performed emergency care to uninsured citizens. Mandatory work is to monitor the availability of the right medication.
Responsibility
The medical insurance company bears financial responsibility for the insufficient performance of its activities, which is fixed in the contract. Their work is under the control of the MHI fund. If he finds a violation, then according to the results of the audit, the organization will be required to fulfill a fine.
The responsibility of policyholders include the refusal to register in the CHI. Responsibility is provided for non-observance of the time of transfer of contributions. Fines are issued to officials.
Choosing an Insurance Company
In order for the services to be performed in a timely and high-quality manner, the right choice of the insurance medical organization is important. This issue must be treated carefully, as it will provide protection. First you need to choose a company with a positive reputation. Need to know about:
- performance of work;
- customer reviews;
- the presence of a "hot line";
- number of claims;
- results of quality examinations;
- the availability of professional workers;
- judicial protection system.
All such information can be found on the official website of the company. You must ensure that it is reliable. It is important to familiarize yourself with the work of the company, as well as learn something useful from people. This and other information is very useful for choosing the right company.
Modern insurance
Today in Russia, the insurance industry is actively developing. Moreover, it has 3 forms:
- state: paid by budget;
- insurance: is created by accumulating deductions of enterprises and contributions of individual entrepreneurs;
- Private: available for a fee.
Everyone has the right to receive quality medical services. This norm allows you to receive the necessary help in a timely manner.
Compulsory medical insurance
Compulsory health insurance is included in the state social program. In it, citizens can take advantage of medical and medical assistance.
The country has a basic and territorial program. They establish what kind of help and where is provided to people living in a certain territory. The first is adopted by the Ministry of Health, and the second by government.
Work rules
Every month, enterprises poison 3.6% of the federal pension funds in compulsory medical insurance: 3.4% go to the territorial compulsory health insurance fund, and 0.2 to the federal one. For non-working citizens, contributions are paid by the state. Each fund is considered an independent organization that regulates the stability of the system.
The accumulated funds are spent on medical services. Insurance companies protect the rights of clients, monitor the timing, volume and quality of assistance provided. Both Russian citizens and non-residents can participate in the program. Only for the latter, the list of available services is less.
Territorial program of compulsory medical insurance
The document includes a list of free services performed. Be sure to provide:
- emergency, outpatient, inpatient care;
- planned hospitalization;
- treatment;
- ambulance;
- provision of medicines on preferential terms;
- expensive types of help.
Paid Services
Although medicine is considered free, there are types of services that patients have to pay for. On a material basis is carried out:
- inspection at the request of citizens;
- anonymous diagnostic and preventive measures;
- anonymous diagnosis and prevention;
- procedures at home;
- vaccinations at the request of citizens;
- treatment in sanatoriums;
- cosmetology services;
- dental prosthetics;
- nursing education.
Policy of compulsory medical insurance
All citizens of Russia, including non-residents who temporarily live in the country, are entitled to draw up this document. The duration of the policy will be equal to the period of stay in the country. Citizens of Russia issue a document once. The insured person may choose the organization that will provide the services.
According to the law, in Russia, after changes in passport data or moving to a new place, you must pass a policy and get a new one. If the document has been lost, then the insurer must be notified about this within a short time. After that, the process of filling out a new document will begin.
VHI
Voluntary medical insurance provides an opportunity to receive additional services besides compulsory medical insurance. The program can be used by individuals, enterprises, organizations. A person has the right to receive expensive services.
VHI is regulated by contract. According to it, the company undertakes to pay for the services that are prescribed in it. The document should indicate that the insured person transfers contributions at a specific time.
Health insurance has some difficulties in the operation of the system. This is due to funding cuts. The current tariff of 3.6% cannot provide coverage for medical care even for the working population. The sphere will develop if the necessary funds are available.