The rules of mandatory medical insurance have changed considerably
Key developmentsGreater focus is placed on preventing diseases. For instance, people who should be examined by a doctor regularly for preventive purposes in view of their chronic conditions will be sent mandatory notifications informing them that it is time to undergo preventive medical checks. This function is to be performed by both medical personnel and representatives of insurance companies that issue mandatory medical insurance policies.
Insurance companies will protect the insured person’s rights at the pre-trial stage and process complaints regarding low quality medical aid or charges for medical aid that should be covered by the local mandatory medical insurance. In addition, insurance companies are obliged to perform medical and economic evaluations and/or expert reviews of the quality of medical aid if a patient has concerns about the quality of medical assistance provided. However, it should be noted that an expert review is a right rather than an obligation of the insurance companies.
|Insurance companies are now required to place on their own official web pages and publish in the media information about breaches identified in medical institutions in terms of providing medical assistance, including, for instance, in connection with a refusal to render medical aid covered by mandatory medical insurance or with individuals being charged for such medical assistance covered by mandatory medical insurance.
In the next two years an overall health assessment and preventive check-up of the entire population will be conducted. Such a check-up will determine the basic level of health of the entire Russian population and will identify the most frequent diseases, including those of them that often become chronic. Further to the overall comprehensive health assessment, each individual will have a health group assigned to him/her.
The register of medical organisations working in the compulsory medical insurance sector will include new information about companies, such as profiles of medical aid rendered under local mandatory medical insurance programmes, the location and address of the medical institution’s branch (representative) office, and contact details of the institution's administration.
|Medical institutions will be required to include more data in the notification of the entry in the register. Among other things, it will be required to include information about diagnostic and consulting services actually rendered in the previous year, the number of insured individuals to whom urgent medical aid has been provided and the area in which they receive the services.
What to think about and what to do
Please note that the changes regarding patients who require regular preventive checks being notified on a regular basis are not accompanied by any information about where to procure resources (both human and technical) to implement this plan. Moreover, it is not clarified how this procedure should be carried out if the personnel lacks time to perform their current job functions.
We recommend becoming familiarised with the new rules, carefully studying the new information included in registers of companies and preparing draft notifications complying with the new rules.
In addition, we recommend taking action to structure the report on the medical institution’s activities, because this information will be entered in the register, which means that it must be precise and accurate.
Help from your adviser
Pepeliaev Group's lawyers are ready to provide comprehensive legal assistance in view of the amendments to legislation, advise you on the relevant medical insurance issues and provide services connected with resolving complex legal disputes in the area of mandatory medical insurance.