The Compulsory Medical Insurance Fund is an institution that implements the state policy in the field of medical civil insurance. Further, we will discuss the main functions and tasks of this system, as well as its budget and contributions.
Basic concepts
The Mandatory Health Insurance Fund is an organization operating in accordance with the Constitution, federal laws, decrees of the President of the Russian Federation, and, in addition, decrees and orders of the Government of the state. This is an independent non-profit financial and credit institution.
The Mandatory Health Insurance Fund is a legal entity that has its own balance sheet along with separate property, an account with the institutions of the Central Bank and other credit companies. MHI has a seal with its own name, forms and stamps of a standard form. Next, we find out which state document accompanies control over the tasks and functions of the CHI system.
the federal law
What law governs the compulsory health insurance fund? Federal Law No. 326. The document is called “On Compulsory Medical Insurance in the Russian Federation”. Further, we will focus on the purpose of the system under consideration.
The main functions and tasks of the compulsory medical insurance fund
The above regulatory document defines this fund as an independent participant in the health insurance system and transfers certain functions related to this field of activity to it. The basic tasks of the fund, in accordance with existing regulatory legal acts, include the following:
- Realization of the rights of citizens to receive free medical care in the framework of the standards established by law.
- The provision of insurance indemnities upon the occurrence of relevant cases that fall under the scope of the compulsory medical insurance program.
- Ensuring citizens' access to medical services and procedures. This should be possible absolutely for all insured persons.
- Conducting outreach and information activities.
- Holding employers and others liable.
- Formation of reports and maintaining an information database on insured citizens.
Territorial fund of medical compulsory insurance
The main tasks of the territorial MHI fund are:
- Securing the rights stipulated by the legislation of the Russian Federation in the field of medical insurance.
- The provision of guarantees for the free provision of medical care to citizens upon the occurrence of insured events as part of territorial programs.
- Creation of the required conditions in order to ensure the availability and quality of medical care, which is provided in the framework of medical insurance, which is mandatory.
- Providing a state guarantee of observance of rights for all insured citizens, regardless of financial situation.
Powers of the territorial fund
The Territorial Compulsory Health Insurance Fund is a body that deals with the following:
- Taking part in the development of a territorial program of state guarantees of free medical assistance to citizens and setting tariffs for paying for services.
- Accumulation of medical insurance funds and their management along with the implementation of financial support for the implementation of territorial programs.
- Receipt from the authority that exercises control over the correctness of estimates, timely payment of insurance premiums.
- Collection of necessary information for the implementation of compulsory medical insurance.
- The administration of the federal budget budget revenues, which comes from the payment of contributions to services for the non-working population.
- Accrual of arrears on transfers to compulsory insurance of non-working persons.
- Approval of differentiated standards for medical insurance organizations in the manner established by the insurance rules.
- Presentation of claims against policyholders in the interests of insured citizens.
Federal fund of compulsory medical insurance
This structure is one of the extrabudgetary government elements created to finance the medical care of citizens living in Russia. It was launched in 1993. The activities of the structure of the federal fund for compulsory medical insurance are regulated by the Budget Code of the Russian Federation and the law “On Medical Insurance”, as well as other legislative and regulatory acts. Among the main functions:
- The implementation of the alignment of the conditions of activity of territorial organizations that are associated with health insurance and ensuring the financing of relevant programs. What else does the federal MHI fund do?
- Conducting money transfers to implement targeted strategies.
- Exercising control over the intended use of the funds of the system related to compulsory health insurance.
Fund budget
One of the main principles in the framework of compulsory insurance in the field of medicine is the stability of the financial system. The budget of the compulsory medical insurance is composed of revenue, expenditure parts and normalized insurance stocks. His profits consist of:
- Insurance contributions that are deducted by business entities on compulsory medical insurance.
- Funds allocated from regional and federal budgets for the development of the field of activity under consideration.
- Voluntary donations from individuals, and in addition, from various organizations.
- Income received from the placement of temporary free funds.
- Funds received in the form of fines.
Insurance premiums
According to the Federal Law No. 22, the obligation to pay for compulsory medical insurance of working citizens is established by the legislation of the Russian Federation on taxes and fees. The main administrators of the profit of the CHI budget are the tax service and the Pension Fund.
In relation to the main group of payers, insurance premiums to the compulsory medical insurance fund are paid based on a tariff of 5.1%. Payers of insurance premiums who do not make payments in favor of other benefits to individuals transfer financial transfers to compulsory medical insurance in fixed amounts. The procedure for their calculation and payment is established by Articles No. 432 and No. 430 of the Tax Code of the Russian Federation.
MHI Fund and basic principles
The basic principles of the federal compulsory health insurance fund, which are enshrined in law, are as follows:
- The massive nature of the participation of persons living in Russia in various compulsory health insurance programs.
- Providing guaranteed volume and conditions for the provision of medicinal care for the population under the MHI program.
- The factor of the free provision of medical services for the benefit of the population in the framework of compulsory insurance.
- A combination of criteria for mandatory and voluntary services in the field of medicine.
- Voluntary insurance coverage, which is based on special programs.
- Ensuring along with the protection of the rights of insured persons in the general system of compulsory medical insurance.
Where does the main profit of the MHI fund come from?
The profitability of the structure under consideration consists of the following components:
- The provision of insurance premiums from various enterprises.
- Allocations from the state budget.
- Voluntary transfers.
- Profitability from using temporary free cash instruments of the compulsory insurance system.
The Russian Compulsory Health Insurance Fund operates on the following principles:
- Conducting the accumulation of financial resources to ensure compulsory medical insurance.
- Implementation of financing the costs of providing medical care.
- Ensuring equal access for citizens to medical services throughout the country.
- Implementation of federal health programs.
The main money transfers in favor of medical institutions are carried out by territorial funds operating in the system of compulsory medical insurance.
Payments to the mandatory medical insurance fund
Health insurance premiums are set at 3.6% for accrued wages. Of these, 0.2% is allocated to the federal unit, and 3.4% to the territorial structures. In the framework of accounting for settlements with health insurance funds, a passive account No. 69 is used along with a sub-account called “Health insurance transfers”. The amount accrued to the territorial CHI fund is charged to the cost.
Deductions to a pension, medical and social fund are called a single social tax. It can be paid at regressive rates. For this, the enterprise is obliged to fulfill the condition under Article No. 245 of the Tax Code, while the size of the payment, accrued on average per employee, exceeds fifty thousand rubles. At the same time, transfers to employees with the highest rates are not taken into account. In this case, the social single tax is twenty percent instead of 35 under normal conditions. In parallel: a pension fund - 15.8%, medical only 2%, and social 2.2%.
In addition to the above deductions, the company undertakes to charge the insurance premium against occupational diseases and industrial accidents for the amount of wages. Insurance transfer rates are established by federal law No. 17 of 2001 under the title “On Insurance Standards for Compulsory Social Insurance against Occupational Accidents and Occupational Diseases”. Only 22 tariffs, as a rule, from 0.2 to 8.5%.
This is how the funds of compulsory health insurance funds add up.
Health Insurance Features
The demographic situation along with changes in the priorities of the state policy in the field of budget expenditures in many countries leads to increased pressure on legislative sources of financing the health system. Among other things, the role of private money transfer options is increasing.
Thus, even in those countries where the country has traditionally taken a leading position in the financing of health care, the role of medical insurance is significantly increasing. Around the world, where it acts as a rapidly developing industry, there are more and more new insurance products designed to meet the demand in the markets for relevant services. The system is primarily aimed at individual customers. In general, any parameters of medical services are determined by national legislation and the share of state intervention in this industry.
Availability of these opportunities is a key issue in any society. The degree of their prevalence is primarily determined by the share of the service guaranteed by the state (state guarantees). In a number of countries (for example, the USA) virtually all medicine is financed through voluntary medical insurance, while in Europe the most significant source of financial resources is compulsory medical insurance along with state funding.