Insurance Medical Organization: Responsibilities, Responsibility

Insurance operates in many spheres of human life. Often this service has to be formalized for the safety of life and health. A person will need an insurance medical organization, in which it will be necessary to formalize the 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 CHI. Their activities do not take into account the standard insurance contracts. Firms carry out only some of the work of insurers in CHI.

Rights

Companies work on the basis of the norms 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 tariffs, which are also approved by law.

Firms have the right to appeal against the conclusion of a medical institution in assessing the terms, conditions and quality of services. They can choose the institutions of a particular industry that will perform the assistance. Insurance companies participate 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 bring claims to institutions if they have caused damage to the insured person.

Duties

There are not only rights, but also the responsibilities of an insurance medical organization. Employees of the company provide free assistance to their customers. By law, they must keep records of the services they perform. They have a duty to timely transmit to the SMO and the fund information about the insured person and the assistance provided.

An insurance medical organization reports on its work. The funds received can be spent only on purpose. In the activity of the company is the creation and improvement of the system of rules, on which services will be carried out. On its website, employees publish reliable information on the schedule of work, types of services and other points.

The activity of insurance medical organizations is aimed at providing compensation to clients when insured events occur. After providing the policy, it is necessary to familiarize the person with his rights, duties and risks. Within 14 days it is supposed to consider complaints, after which a decision is made.

The firm provides customers with information on the schedule of work, types of services, accessibility, quality. Obligatory activity is sending the fund a report on compliance with contracts. Employees represent the interests of clients in litigation.

Insurance medical organizations and institutions transfer to the fund information on the change of these clients within 14 days. Policies employees issue no later than 5 days after consideration of the application. Firms protect the rights of insured persons. They return the funds to customers, if it is stipulated by the contract. Companies enter into transactions for the provision of medical care to citizens based on VHI.

Other Functions

The medical insurance organization performs additional functions. It provides guarantees to the unprotected strata of the population. Employees participate in the improvement of medical practices. They provide financial assistance to medical organizations that have performed emergency care for uninsured citizens. Obligatory work is to monitor the availability of the necessary drugs.

A responsibility

An insurance medical organization bears financial responsibility for insufficient performance of its activities, which is fixed in the contract. Their work is under the control of the CHI fund. If they find a violation, then according to the results of the inspection, the organization will be obliged to execute the fine.

The responsibility of policyholders is the refusal to register with the MHI. Responsibility is also provided for non-observance of the time of transfer of contributions. Penalties are issued to officials.

Choosing an insurance company

For the services to be performed in a timely and qualitative way, the correct choice of an insurance medical organization is important. This issue should be treated with care, as it will provide protection. First you need to choose a firm with a positive reputation. It is necessary to learn about:

• Performance of work;
• Customer reviews;
• Availability of a hotline;
• Number of claims;
• Results of quality examinations;
• Availability of professional workers;
• System of judicial protection.

All such information can be found on the official website of the company. You need to make sure that it is reliable. It is important to get acquainted 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.

Contemporary Insurance

For today in Russia the sphere of insurance actively develops. And it has 3 forms:

• State: it is paid for by means of the budget;
• Insurance: is created by means of accumulation of enterprise deductions and IP contributions;
• Private: available on a fee basis.

Everyone has the right to receive quality medical services. This provision allows you to receive the necessary assistance in a timely manner.

OMS

Mandatory medical insurance is included in the state social program. In it, citizens can use medicinal and medical help.

The country has a basic and territorial program. They determine what kind of assistance and where it turns out to people living in a certain territory. The first is taken by the Ministry of Health, and the second by the state administration.

Rules of work

Enterprises every month poison 3.6% of the FOP in the compulsory health insurance: 3.4% goes to the regional MHI fund, and 0.2 - to the federal fund. For non-working citizens, contributions are paid by the state. Each fund is considered an independent organization that regulates the stability of the system.

Accrued funds are spent on payment of medical services. Insurance companies protect the rights of clients, monitor the timing, volumes and quality of the 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 provided. Be sure to provide:

• Emergency, outpatient, inpatient care;
• Planned hospitalization;
• treatment;
• First aid;
• Provision of medicines on preferential terms;
• Expensive types of assistance.

Paid services

Although medicine is considered free, but there are types of services for which patients must pay. On a material basis:

• Examination at will of citizens;
• Anonymous diagnostic and preventive measures;
• Anonymous diagnosis and prevention;
• Procedures at home;
• Vaccinations at the request of citizens;
• Treatment in sanatoria;
• Cosmetology services;
• Dental prosthetics;
• Training in the care of patients.

MHI policy

All citizens of Russia, including non-residents who temporarily live in the country, have the right to register this document. The period of validity of the policy will be equal to the period of stay in the country. Citizens of Russia the document is issued once. The insured person can choose the organization that will perform the services.

By law, in Russia, after changes in passport data or moving to a new location, you must pass the policy and get a new one. If the document was lost, then it should be notified to the insurer within a short time. After this, the procedure for issuing a new document will begin.

LCA

Voluntary health insurance provides an opportunity to receive additional services in addition to CHI. The program can be used by individuals, businesses, organizations. A person has the right to receive expensive services.

VHI is governed by the contract. Under it, the company undertakes to pay for the services that are prescribed in it. The document should indicate that the insured person remits the contributions at a certain time.

Medical insurance has some difficulties in the operation of the system. This is due to reductions in funding. The current tariff of 3.6% can not provide coverage for medical care even for the working population. The sphere will develop with the necessary means.