Insurance medical organization: duties, responsibility

2024 Author: Howard Calhoun | [email protected]. Last modified: 2023-12-17 10:16

Insurance operates in many areas of human life. Often this service has to be issued for the safety of life and he alth. 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 compulsory medical insurance services. Their activities do not take into account standard insurance contracts. Firms carry out only some part of the work of insurers in CHI.

Rights

Companies operate on the basis of the law. They also establish the rights of insurance medical organizations. Companies work to receive monetary rewards for services rendered. Their activities are carried out at specific rates, which are also approved by law.

Firms have the right to appeal against the opinion of a medical institution on the assessment of the terms, conditions and quality of services. They arecan choose establishments of a specific industry that will provide 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 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 clients. By law, they must keep records of the services they perform. They have an obligation to timely transfer information about the insured person and the assistance provided to the HIO and the fund.

The he alth insurance organization sends reports on its work. Funds received can only be used for their intended purpose. The company's activities include the creation and improvement of a system of rules according to which services will be provided. On their website, employees publish reliable information on work schedules, types of services and other points.

The activity of insurance medical organizations is aimed at providing compensation to clients in the event of insured events. After providing the policy, it is necessary to inform the person about his rights, obligations and risks. Complaints are supposed to be considered within 14 days, after which a decision is made.

The firm provides clients with information about work schedule, types of services, availability, quality. Mandatory activityis to send the fund a report on compliance with the agreements. Employees of the organization represent the interests of clients in litigation.

Insurance medical organizations and institutions transfer 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 it is stipulated by the contract. Companies enter into transactions to provide medical assistance to citizens on the basis of VHI.

Other functions

The insurance medical organization also performs additional functions. It provides guarantees to vulnerable sections of the population. Employees are involved in improving medical practices. They provide financial assistance to medical organizations that have performed emergency care for uninsured citizens. Mandatory work is to control the availability of the necessary medicines.

Responsibility

An insurance medical organization is financially responsible for the 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, based on the results of the audit, the organization will be required to comply with the fine.

Responsibility of policyholders include refusal to register in the MHI. Responsibility is also provided for non-compliance with the time of transfer of contributions. Fines are issued to officials.

Choosing an insurance company

For services to be performedtimely and efficiently, the right choice of an insurance medical organization is important. This issue must be treated carefully, as it will provide protection. First you need to choose firms with a positive reputation. Need to know about:

• doing work;
• customer reviews;
• availability of "hot line";
• number of claims;
• results of quality examinations;
• availability of professional workers;
• to the judicial protection system.

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 firm.

Modern insurance

Today, the insurance industry is actively developing in Russia. Moreover, it has 3 forms:

• state: paid for by the budget;
• insurance: created by accumulating deductions from enterprises and individual entrepreneur contributions;
• private: available for a fee.

Everyone has the right to receive quality he alth care. This norm allows you to receive the necessary assistance in a timely manner.

CMI

Compulsory he alth insurance is included in the state social program. In it, citizens can take advantage of medicinal and medical assistance.

Basic andterritorial programs. They establish what kind of assistance and where it is provided to people living in a certain territory. The first is accepted by the Ministry of He alth, and the second - by the state authorities.

Operating rules

Enterprises every month send 3.6% of the FOP to compulsory medical insurance: 3.4% goes to the territorial fund of compulsory medical insurance, and 0.2% to the federal one. Contributions for non-working citizens 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 paying for medical services. Insurance companies protect the rights of clients, monitor the timing, volume and quality of assistance provided. Both citizens of the Russian Federation and non-residents can participate in the program. Only for the latter, the list of available services is smaller.

Territorial CHI program

The document includes a list of free services performed. Required:

• 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 for which patients have to pay. On a material basis is carried out:

• examination at the request of citizens;
• anonymous diagnostic and preventive measures;
• anonymous diagnosis and prevention;
• proceduresat home;
• vaccinations at the request of citizens;
• treatment in sanatoriums;
• cosmetic services;
• prosthetics;
• care training.

CMI policy

All citizens of Russia, including non-residents who temporarily live in the country, have the right to issue this document. The duration 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 provide the services.

According to the law, in Russia, after changes in passport data or moving to a new place, you must hand over the 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 procedure for issuing a new document will begin.

VHI

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

VHI is governed by the 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 certain time.

He alth insurance has some problems with the system. This is due to funding cuts. The current tariff of 3.6% cannot cover medical care even for the working population. The sphere will develop withfunds available.