Compulsory Health Insurance (MHI)

Compulsory medical insurance (MHI) is a form of social insurance produced without fail, designed to provide citizens with an insured event with a minimum of free medical care provided at the expense of the budget and extra-budgetary funds, in accordance with the approved program of compulsory medical insurance and within the limits established by federal legislation.

Compulsory Health Insurance Program

The compulsory medical insurance program provides for the following types of medical care:1. Primary health care;2. Ambulance; 3. Specialized medical care only with:

  • infectious and parasitic diseases, excluding sexually transmitted diseases, tuberculosis, HIV infection and acquired syndrome  
  • immunodeficiency;
  • neoplasms;
  • diseases of the endocrine system;
  • eating disorders and metabolic disorders;
  • diseases of the nervous system;
  • diseases of the blood, blood-forming organs;
  • individual disorders involving the immune mechanism;
  • diseases of the eye and its adnexa;
  • diseases of the ear and mastoid process;
  • circulatory system diseases;
  • respiratory diseases;
  • digestive diseases;
  • diseases of the genitourinary system;
  • diseases of the skin and subcutaneous tissue;
  • diseases of the musculoskeletal system and connective tissue;
  • injuries, poisoning and some other consequences of exposure to external causes;
  • congenital malformations (malformations);
  • deformations and chromosomal abnormalities;
  • pregnancy, childbirth, the postpartum period and abortion;
  • certain conditions that occur in children in the perinatal period.

 Republics, territories, regions may provide for the provision of additional types of assistance to the basic program of compulsory medical insurance, but at their own expense.  All citizens of Russia at the expense of the federal budget and extra-budgetary funds are guaranteed to provide the following types of medical care free of charge:

  • ambulance;
  • outpatient and inpatient (hospital) care;
  • preferential drug provision and prosthetics (dental, ocular, ear);
  • vaccination of the population;
  • expensive types of treatment, the list of which is approved at the federal level;
  • Fluorographic examinations to detect diseases in the early stages;
  • medical care for children with congenital abnormalities, deformations and chromosomal disorders that occur in the perinatal period;
  • medical care for cancer;
  • dental care.

Insured in compulsory medical insurance

Policyholders in compulsory health insurance are:

  • for unemployed citizens – these are local governments, subjects of the Russian Federation;
  • for working citizens – these are employers – organizations and individual entrepreneurs;
  • individual entrepreneurs working alone;
  • notary;
  • lawyer;
  • the policyholder will also be an individual who hired an employee and entered into an employment contract with him.

Insurance Medical Organization (Insurer)

An insurance medical organization (insurer) is an insurance company specializing in compulsory medical insurance insurance and monitoring the expenditure of funds by medical institutions, as well as the completeness and quality of services provided by medical institutions. Activities in the field of compulsory health insurance are subject to compulsory licensing. Insurance companies cannot carry out activities in the field of compulsory medical insurance without an appropriate license. The medical insurance company is responsible for non-fulfillment or improper fulfillment of its obligations under the compulsory medical insurance agreement in accordance with the current legislation of the Russian Federation. 

Compulsory medical insurance agreement

A compulsory medical insurance contract is a written agreement concluded between the insurer and the policyholder, on the basis of which the insurer undertakes to organize the provision of free medical care to the insured person and to exercise financial control over the activities of medical institutions, and the policyholder undertakes to pay the insurance premiums stipulated by the contract. The form of the contract of compulsory medical insurance, the procedure for its conclusion and the conditions that must be contained in it are established by the government of the Russian Federation. But it must contain information about:

  • names of parties;
  • terms of the contract;
  • the number of citizens subject to insurance;
  • making insurance premiums;
  • rights and obligations of the parties;
  • responsibility of the parties.

 It is worth noting that the compulsory medical insurance agreement is concluded between the insured and the insurer, and the insured – the citizen, i.e. we are issued a compulsory health insurance policy. The MHI policy has the force of an agreement. Since 2011, namely from 01.05.2011, on the territory of the Russian Federation, on the basis of Federal Law of 29.11.2010 N 326-ФЗ “On Compulsory Health Insurance in the Russian Federation”, a unified compulsory medical insurance policy has been introduced. To replace an old-school MHI policy with a new one, you must contact an insurance medical organization that will issue a temporary certificate (valid for the MHI policy) in place of the old policy, it confirms the fact that a new policy is issued for 30 days. You can also contact him for medical help within 30 days and cannot refuse to provide you with it. And as your individual MHI policy is ready, and this takes no more than one month, you will be notified of the time and place of receipt of the policy. Read more about the procedure for obtaining a policy in the article “How to get a compulsory health insurance policy”, with detailed instructions. Compulsory medical insurance policies of a single sample are valid throughout the Russian Federation and do not need to be exchanged when changing jobs, places of residence. For information: Validity period of old-age medical insurance policies until 01.01.2014 

Mandatory Health Insurance Contributions

 Insurance premiums for compulsory health insurance are paid by policyholders, namely:

  • for non-working citizens – regional authorities and local authorities;
  • for working citizens – the employer, organization or individual entrepreneur;
  • individual entrepreneurs working alone;
  • notary;
  • lawyer;
  • individuals hiring an employee.

Rates of premiums to the Federal Compulsory Medical Insurance Fund (FFOMS) in 2013

 1. For all policyholders (except as noted below): 

Base for calculating insurance premiumsPremium rate
Federal Compulsory Health Insurance Fund
Within 568 000 rubles5.1 percent
Over 568,000 rubles0.0 percent

2. For organizations that have received the status of a project participant in the implementation of research, development and commercialization of their results in accordance with Federal Law of September 28, 2010 N 244-ФЗ “On the Skolkovo Innovation Center”, from the day they receive the status of a project participant starting from 1 on the month of the month following the month in which they obtained the status of a project participant, the following insurance premium rates apply:

NameRate
Federal Compulsory Health Insurance Fund0.0 percent

3. Reduced rates of insurance premiums for the following categories of policyholders: 

  • agricultural producers meeting the criteria specified in Article 346.2 of the Tax Code of the Russian Federation for organizations of folk arts and crafts and family (clan) communities of indigenous peoples of the North engaged in traditional economic sectors;
  • organizations and individual entrepreneurs applying a single agricultural tax;
  • payers of insurance premiums making payments and other remuneration to individuals who are disabled persons of I, II or III group – in relation to the said payments and remuneration;
  • public organizations of people with disabilities, for organizations whose authorized capital consists entirely of contributions from public organizations of people with disabilities and in which the average number of people with disabilities is at least 50 percent, and the proportion of people with disabilities in the payroll is at least 25 percent;
  • institutions created to achieve educational, cultural, medical, recreational, sports, scientific, informational and other social goals, as well as to provide legal and other assistance to persons with disabilities, children with disabilities and their parents (other legal representatives), the sole owners of property which are public organizations of persons with disabilities, with the exception of payers of insurance premiums engaged in the production and (or) sale of excisable goods, minerals, other minerals, as well as other goods in accordance with the list approved by the Government of the Russian Federation on the proposal of all-Russian public organizations of persons with disabilities
NameRate
Federal Compulsory Health Insurance Fund3.7 percent

4. Reduced rates of insurance premiums for the following categories of policyholders:

  • business associations created after August 13, 2009 by budget research institutions in accordance with the Federal Law of August 23, 1996 N 127-ФЗ “On Science and State Scientific and Technical Policy” and higher education institutions in accordance with the Federal Law of August 22 1996 N 125-ФЗ “On Higher and Postgraduate Professional Education”. The register of notifications on the establishment of business entities is maintained by the federal executive body authorized by the Government of the Russian Federation and submitted to the control body for the payment of insurance premiums no later than the 1st day of the month following the reporting period, in the manner determined by the Government of the Russian Federation;
  • organizations and individual entrepreneurs who have concluded agreements with the authorities of special economic zones on the implementation of technology-innovative activities and make payments to individuals working in the technology-innovative special economic zone or industrial-production special economic zone for organizations and individual entrepreneurs who have concluded agreements on carrying out tourist and recreational activities and making payments to individuals working in the tourist industry creation special economic zones, united by a decision of the Government of the Russian Federation into a cluster;
  • for organizations operating in the field of information technology (with the exception of organizations that have concluded agreements with the authorities of special economic zones on the implementation of technology and innovation activities and make payments to individuals working in the technology and innovation special economic zone or industrial and industrial special economic zone) which are recognized by Russian organizations involved in the development and implementation of their computer programs, databases on material carrier or in electronic form via communication channels, regardless of the type of contract and (or) providing services (performing work) for the development, adaptation, modification of computer programs, databases (software and information products of computer technology), installation,
NameRate
Federal Compulsory Health Insurance Fund4.0 percent

5. For Russian organizations and individual entrepreneurs engaged in the production, publication (broadcast) and (or) publication of mass media (with the exception of mass media specializing in messages and materials of an advertising and (or) erotic nature), including including in electronic form, the main economic activity of which is:

  • activities in the field of recreation and entertainment, culture and sports – in terms of activities in the field of broadcasting and television broadcasting or the activities of news agencies;
  • publishing and printing activities, replication of recorded media – in terms of publishing newspapers or magazines and periodicals, including interactive publications.
NameRate
Federal Compulsory Health Insurance Fund3.5 percent

6. For payers of insurance premiums making payments and other remuneration to crew members of ships registered in the Russian International Register of Ships for the performance of the duties of a crew member of a ship, in relation to the said payments and remuneration:

NameRate
Federal Compulsory Health Insurance Fund0.0 percent

7. For organizations and individual entrepreneurs applying the simplified tax system, the main type of economic activity (classified in accordance with OKVED) which are:

  • food production;
  • production of mineral waters and other soft drinks;
  • textile and clothing production;
  • manufacture of leather, leather products and footwear;
  • wood processing and the manufacture of wood products;
  • chemical production;
  • manufacture of rubber and plastic products;
  • production of other non-metallic mineral products;
  • manufacture of finished metal products;
  • production of machinery and equipment;
  • manufacture of electrical equipment, electronic and optical equipment;
  • production of vehicles and equipment;
  • furniture manufacture;
  • production of sporting goods;
  • production of games and toys;
  • research and development;
  • education;
  • health and social services;
  • activities of sports facilities;
  • other sports activities;
  • processing of secondary raw materials;
  • building;
  • maintenance and repair of motor vehicles;
  • disposal of wastewater, waste and similar activities;
  • transport and communication;
  • the provision of personal services;
  • production of pulp, wood pulp, paper, cardboard and products from them;
  • production of musical instruments;
  • production of various products not included in other groups;
  • repair of household goods and personal items;
  • real estate management;
  • activities related to the production, distribution and screening of films;
  • the activities of libraries, archives, club-type institutions (with the exception of clubs);
  • museums and the protection of historic sites and buildings;
  • the activities of botanical gardens, zoos and reserves;
  • activities related to the use of computer technology and information technology, with the exception of organizations and individual entrepreneurs referred to in paragraphs 5 and 6 of part 1 of article 58 of the Federal Law of July 24, 2009 N 212-ФЗ;
  • retail trade in pharmaceutical and medical goods, orthopedic products;
  • production of bent steel profiles;
  • steel wire production
NameRate
Federal Compulsory Health Insurance Fund0.0 percent

8. Reduced rates of insurance premiums for the following categories of policyholders:

  • pharmacy organizations recognized as such in accordance with Federal Law of April 12, 2010 N 61-ФЗ “On the Circulation of Medicines” and paying a single tax on imputed income for certain types of activities, as well as for individual entrepreneurs licensed for pharmaceutical activities and paying single tax on imputed income for certain types of activities, in relation to payments and remunerations made to individuals in connection with the implementation of pharmaceutical activities;
  • non-profit organizations (with the exception of state (municipal) institutions) registered in the manner prescribed by the legislation of the Russian Federation, applying a simplified taxation system and carrying out activities in the field of social services, research and development, education, healthcare, culture and art in accordance with constituent documents (activities of theaters, libraries, museums and archives) and mass sports (except professional);
  • charitable organizations registered in the manner prescribed by the legislation of the Russian Federation and applying a simplified taxation system;
  • individual entrepreneurs applying the patent system of taxation, with the exception of individual entrepreneurs engaged in entrepreneurial activities specified in subparagraphs 19, 45 – 47 of paragraph 2> article 346.43 of the Tax Code of the Russian Federation.
NameRate
Federal Compulsory Health Insurance Fund0.0 percent

9. For organizations that provide engineering services, with the exception of organizations that have concluded agreements with the authorities of special economic zones on the implementation of technical and innovative activities:

NameRate
Federal Compulsory Health Insurance Fund5.1 percent

Insurance premium rates for insurers who do not pay to individuals

Fixed amount of insurance premiumFederal Compulsory Health Insurance Fund
Minimum wage x Tariff x 125.1 percent

The maximum size of the base for calculating insurance premiums for each individual is set in an amount not exceeding 568,000 rubles cumulatively from the beginning of the billing period. From the sums of payments and other remuneration in favor of an individual exceeding 568,000 rubles on an accrual basis from the beginning of the billing period, insurance premiums are not charged, unless otherwise provided by Federal Law of 24.07.09 N 212-ФЗ.

One Comments

  • Justin

    August 20, 2019

    Peace to your home. Thank you for the wonderful articles.

    Reply

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