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FEDERAL LAW OF THE RUSSIAN FEDERATION

of November 29, 2010 No. 326-FZ

About compulsory medical insurance in the Russian Federation

(as amended on 08-12-2020)

Accepted by the State Duma of the Russian Federation on November 19, 2010

Approved by Council of the Russian Federation on November 24, 2010

Chapter 1. General provisions

Article 1. Subject of regulation of this Federal Law

This Federal Law governs the relations arising in connection with implementation of compulsory medical insurance including determines legal status of subjects of compulsory medical insurance and participants of compulsory medical insurance, the basis of emergence of their rights and obligations, guarantees of their realization, the relation and the responsibility connected with payment of insurance premiums for compulsory medical insurance of the idle population.

Article 2. Legal basis of compulsory medical insurance

1. The legislation on compulsory medical insurance is based on the Constitution of the Russian Federation and No. 323-FZ "About bases of protection of public health in the Russian Federation", the Federal Law of July 16, 1999 No. 165-FZ "About bases of compulsory social insurance", this Federal Law, other Federal Laws, the laws of subjects of the Russian Federation consists of the Federal Law of November 21, 2011. The relations connected with compulsory medical insurance are regulated also by other regulatory legal acts of the Russian Federation, other regulatory legal acts of subjects of the Russian Federation.

2. If the international treaty of the Russian Federation establishes other rules, than provided by this Federal Law rules of the international treaty of the Russian Federation are applied.

2.1. The decisions of interstate bodies made based on provisions of international treaties of the Russian Federation in their interpretation contradicting the Constitution of the Russian Federation are not subject to execution in the Russian Federation. Such contradiction can be established according to the procedure, determined by the Federal constitutional Law.

3. For the purpose of uniform application of this Federal Law if necessary the corresponding explanations according to the procedure, established by the Government of the Russian Federation can be published.

Article 3. The basic concepts used in this Federal Law

For the purposes of this Federal Law the following basic concepts are used:

1) compulsory medical insurance - the type of compulsory social insurance representing system of the legal, economic and organizational measures created by the state aimed at providing in case of loss occurrence of guarantees of free rendering medical care to insured person at the expense of means of compulsory medical insurance within the territorial program of compulsory medical insurance and in the cases established by this Federal Law within the basic program of compulsory medical insurance;

2) object of compulsory medical insurance - the insurance risk connected with emergence of insured event;

3) insurance risk - expected event in case of which approach there is need of implementation of expenses on payment of the medical care provided to insured person;

4) insured event - the made event (disease, injury, other state of health of insured person, preventive actions) in case of which approach insurance coverage for compulsory medical insurance is provided to insured person;

5) insurance coverage for compulsory medical insurance (further - insurance coverage) - obligation fulfillment on provision to insured person of necessary medical care in case of loss occurrence and on its payment of the medical organization;

6) insurance premiums for compulsory medical insurance - obligatory payments which are paid by insurers have the depersonalized nature and which purpose is providing the rights of insured person to receipt of insurance coverage;

7) insured person - physical person to which compulsory medical insurance according to this Federal Law extends;

8) the basic program of compulsory medical insurance - the component of the program of the state guarantees of free rendering medical care to citizens determining the rights of insured persons to free rendering by it at the expense of means of compulsory medical insurance in all territory of the Russian Federation of medical care and establishing single requirements to territorial programs of compulsory medical insurance;

9) the territorial program of compulsory medical insurance - the component of the territorial program of the state guarantees of free rendering medical care to citizens determining the rights of insured persons to free rendering medical care to them in the territory of the subject of the Russian Federation and conforming to single requirements of the basic program of compulsory medical insurance.

Article 4. Basic principles of implementation of compulsory medical insurance

The basic principles of implementation of compulsory medical insurance are:

1) providing at the expense of means of compulsory medical insurance of guarantees of free rendering medical care to insured person in case of loss occurrence within the territorial program of compulsory medical insurance and the basic program of compulsory medical insurance (further also - programs of compulsory medical insurance);

2) the stability of financial system of compulsory medical insurance provided on the basis of equivalence of insurance coverage to means of compulsory medical insurance;

3) obligation of payment by insurers of insurance premiums for compulsory medical insurance in the sizes established by the Federal Laws;

4) the state guarantee of observance of the rights of insured persons for obligation fulfillment on compulsory medical insurance within the basic program of compulsory medical insurance irrespective of financial position of the insurer;

5) creation of conditions for ensuring availability and quality of the medical care provided within programs of compulsory medical insurance;

6) equal share of representation of subjects of compulsory medical insurance and participants of compulsory medical insurance in governing bodies of compulsory medical insurance.

Chapter 2. Powers of the Russian Federation and subjects of the Russian Federation in the sphere of compulsory medical insurance

Article 5. Powers of the Russian Federation in the sphere of compulsory medical insurance

In the sphere of compulsory medical insurance treat powers of the Russian Federation:

1) development and realization of state policy in the sphere of compulsory medical insurance;

2) organization of compulsory medical insurance in the territory of the Russian Federation;

3) establishment of the group of people, subject to compulsory medical insurance;

4) establishment of rates of insurance premiums for compulsory medical insurance and procedure for collection of insurance premiums for compulsory medical insurance;

5) approval of the basic program of compulsory medical insurance and single requirements to territorial programs of compulsory medical insurance;

6) establishment of procedure for distribution, provision and expenditure of subventions from the budget of Federal Compulsory Health Insurance Fund to budgets of territorial funds of compulsory medical insurance;

7) establishment of responsibility of subjects of compulsory medical insurance and participants of compulsory medical insurance for violation of the law about compulsory medical insurance;

8) organization of management of means of compulsory medical insurance;

9) determination of the general principles of the organization of information systems and information exchange in the sphere of compulsory medical insurance, conducting the personified accounting of information about insured persons and the personified accounting of data on the medical care provided to insured persons;

10) establishment of system of protection of the rights of insured persons in the sphere of compulsory medical insurance;

11) financial provision of provision to insured persons of the specialized, including high-technology, medical care provided by the medical organizations, functions and powers of founders concerning which perform the Government of the Russian Federation or federal executive bodies (further - the medical organizations subordinated to federal executive bodies) according to single requirements of the basic program of compulsory medical insurance.

Article 6. The powers of the Russian Federation in the sphere of compulsory medical insurance delegated for implementation to public authorities of subjects of the Russian Federation

1. The organization of compulsory medical insurance in the territories of subjects of the Russian Federation according to the requirements established by this Federal Law treats the powers of the Russian Federation in the sphere of compulsory medical insurance delegated for implementation to public authorities of subjects of the Russian Federation including:

1) approval of the territorial programs of compulsory medical insurance conforming to single requirements of the basic program of compulsory medical insurance and implementation of the basic program of compulsory medical insurance in the territories of subjects of the Russian Federation in limits and at the expense of the subventions provided from the budget of Federal Compulsory Health Insurance Fund to budgets of territorial funds of compulsory medical insurance;

2) approval of the differentiated per capita standard rates of financial provision of compulsory medical insurance (further - the differentiated per capita standard rates) in the territories of subjects of the Russian Federation according to the rules of compulsory medical insurance approved by the authorized Government of the Russian Federation federal executive body (further - rules of compulsory medical insurance), for medical insurance companies;

3) registration and removal from registration accounting of insurers for unemployed citizens;

4) administration of the budget receipts of Federal Compulsory Health Insurance Fund arriving from payment of insurance premiums for compulsory medical insurance of the idle population in the territories of subjects of the Russian Federation;

5) control of use of means of compulsory medical insurance in the territories of subjects of the Russian Federation, including conducting checks and audits;

6) financial provision of the medical care provided to insured persons outside the territory of the subject of the Russian Federation in which the policy of compulsory medical insurance, according to single requirements of the basic program of compulsory medical insurance, except for is issued to medical care which financial provision is performed according to Item 11 of article 5 of this Federal Law;

7) providing the rights of citizens in the sphere of compulsory medical insurance in the territories of subjects of the Russian Federation;

8) conducting the personified accounting of information about insured persons in the form of regional segment of the single register of insured persons, and also the personified accounting of data on the medical care provided to insured persons;

9) accounting in the sphere of compulsory medical insurance.

2. Financial provision of payment commitments of the subjects of the Russian Federation arising when implementing of 1 this Article of powers transferred according to part is performed at the expense of the subventions provided from the budget of Federal Compulsory Health Insurance Fund to budgets of territorial funds of compulsory medical insurance.

3. The management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation) when implementing of 1 this Article of powers transferred according to part:

1) will be organized by activities for implementation of delegated powers according to the Federal Laws and other regulatory legal acts of the Russian Federation;

Provides 2) in accordance with the established procedure:

a) decision making about creation in case of absence in the territory of the subject of the Russian Federation of non-profit organization of territorial fund of compulsory medical insurance (further - territorial fund);

b) approval of management structure of territorial fund in coordination with Federal Compulsory Health Insurance Fund (further - Federal fund);

c) position assignment and dismissal of the head of territorial fund in coordination with Federal fund;

3) is provided in accordance with the established procedure by timely representation in the federal executive body authorized by the Government of the Russian Federation (further - authorized federal executive body) and Federal fund:

a) the reporting on implementation of delegated powers, on expenditure of the provided subventions, achievement of target forecast indicators (if such indicators are established) in the established form;

b) the regulatory legal acts adopted by public authorities of subjects of the Russian Federation on implementation of delegated powers within three days after day of their acceptance;

c) data (including databases), insured persons, necessary for maintaining the single register;

d) data on forecast indicators on implementation of delegated powers in the established form;

e) other information provided by this Federal Law and (or) other regulatory legal acts of the Russian Federation accepted according to it.

4. Control of use of the means of compulsory medical insurance providing implementation of 1 this Article of powers transferred according to part is carried out by the Federal fund, federal executive body performing functions on control and supervision in the financial and budget sphere, Audit Chamber of the Russian Federation.

Article 7. The rights and obligations of authorized federal executive body and Federal fund for implementation of delegated powers of the Russian Federation in the sphere of compulsory medical insurance by public authorities of subjects of the Russian Federation

1. The authorized federal executive body performs the following rights and obligations on implementation of the powers delegated according to part 1 of article 6 of this Federal Law:

1) publishes regulatory legal acts and methodical instructions for implementation of subjects of the Russian Federation of delegated powers by public authorities;

2) exercises in the procedure established by it supervision of the normative legal regulation performed by public authorities of subjects of the Russian Federation concerning delegated powers with the right of the direction of instructions, obligatory for execution, about cancellation of regulatory legal acts or about introduction of changes in them;

3) exercises control of efficiency and quality of implementation by public authorities of subjects of the Russian Federation of delegated powers with the right of the direction of instructions, obligatory for execution, about elimination of the revealed violations, and also about attraction to disciplinary responsibility of officials of public authorities of subjects of the Russian Federation and territorial funds for non-execution or improper execution of delegated powers. The procedure of control of efficiency and quality of implementation of delegated powers affirms authorized federal executive body according to the rules established by the Government of the Russian Federation;

a) about elimination of the revealed violations;

b) about attraction to the responsibility of officials of public authorities of subjects of the Russian Federation and territorial funds established by the legislation of the Russian Federation;

Prepares 4) and sends to the management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation) of the offer on discharge from position of officials of public authorities of subjects of the Russian Federation and territorial funds;

5) has the right to establish target forecast indicators on implementation of delegated powers;

6) approves rules of compulsory medical insurance, including method of calculation of rates for payment of medical care, method of calculation of amounts of financial provision of medical care and payment procedure of medical care on compulsory medical insurance;

7) is determined by procedure for conducting the personified accounting in the sphere of compulsory medical insurance;

8) prepares and sends to the Government of the Russian Federation offers on withdrawal of appropriate authority at public authorities of subjects of the Russian Federation according to the procedure, the stipulated in Clause 7.1 presents of the Federal Law;

9) is established by procedure for compensation of the subventions provided from the budget of Federal fund to budgets of territorial funds for implementation of appropriate authority;

9. 1) is established by procedure for monitoring procedure of amounts, terms, quality and conditions of provision of medical care on compulsory medical insurance to insured persons, and also its financial provision (further also - control of amounts, terms, quality and conditions of provision of medical care);

Performs 10) other established by this Federal Law and other Federal Laws of power.

2. The federal fund performs the following rights and obligations on implementation of the powers delegated according to part 1 of article 6 of this Federal Law:

1) publishes regulatory legal acts and methodical instructions for implementation of delegated powers by territorial funds;

2) provides subventions from the budget of Federal fund to budgets of territorial funds for financial provision of implementation of the powers delegated according to part 1 of article 6 of this Federal Law;

3) exercises control of payment of insurance premiums for compulsory medical insurance of the idle population, including performs activities of territorial funds for accomplishment of functions of the administrator of the budget receipts of Federal fund arriving from payment of insurance premiums for compulsory medical insurance of the idle population, the shortage having the right to charge and collect from insurers for unemployed citizens on the specified insurance premiums, penalty fee and penalties;

4) establishes reporting forms in the sphere of compulsory medical insurance and procedure for its maintaining;

5) ceased to be valid

6) exercises in the procedure established by it control of compliance with law about compulsory medical insurance and behind use of means of compulsory medical insurance, including carries out inspections and audits;

7) exercises control of functioning of information systems and procedure for information exchange in the sphere of compulsory medical insurance;

8) approves structure of territorial funds, position assignment and dismissal of heads of territorial funds, and also standard rates of expenses on ensuring accomplishment by territorial funds of the functions.

Article 7.1. Procedure for withdrawal of the powers of the Russian Federation in the sphere of compulsory medical insurance delegated for implementation to public authorities of subjects of the Russian Federation

1. The powers of the Russian Federation in the sphere of compulsory medical insurance delegated for implementation to public authorities of subjects of the Russian Federation according to part 1 of article 6 of this Federal Law can be withdrawn by the Government of the Russian Federation in case of their non-execution of subjects of the Russian Federation by public authorities revealed by authorized federal executive body and (or) Federal fund when implementing by them of control and supervision of implementation of delegated powers.

2. The authorized federal executive body within 20 working days from the date of identification of the violations specified regarding 1 this Article or obtaining from Federal fund of information on such violations revealed by it sends to the management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation) the instruction containing the description of the revealed violations, term for their elimination and term for the notification of authorized federal executive body and Federal fund on the decision made for the instruction.

3. The management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation) in the time specified in the instruction notifies authorized federal executive body and Federal fund on the decision, including on measures for elimination of the revealed violations made for the instruction in the time established in the instruction.

4. In case of non-execution or execution not in full of the instruction the authorized federal executive body within 20 working days from the date of the termination of the term specified in the instruction for elimination of the revealed violations sends the repeated instruction to the management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation), and also the offer on discharge from position of the corresponding officials of public authorities of the subject of the Russian Federation and (or) territorial fund. The management official of the subject of the Russian Federation (the head of the supreme executive body of the government of the subject of the Russian Federation) in the time specified in the repeated instruction notifies authorized federal executive body and Federal fund on the made decision, including on measures for elimination of the revealed violations at the scheduled time and on result of consideration of the offer of authorized federal executive body on discharge from position of the corresponding officials of public authorities of the subject of the Russian Federation and (or) territorial fund.

5. In case of non-execution or execution not in full of the repeated instruction the authorized federal executive body within 20 working days from the date of the termination of the term specified in the repeated instruction makes in the Government of the Russian Federation the offer on withdrawal at public authorities of the subject of the Russian Federation of delegated powers of the Russian Federation in the sphere of compulsory medical insurance.

6. Powers of the Russian Federation in the sphere of compulsory medical insurance, the stipulated in Item 1 parts 1 of article 6 of this Federal Law withdrawn from public authorities of subjects of the Russian Federation are performed by the federal executive body performing functions on development of state policy and normative legal regulation in health sector, and the powers established by Items 2 - 9 parts 1 of article 6 of this Federal Law withdrawn from public authorities of subjects of the Russian Federation are performed by Federal fund and (or) territorial fund according to the decision of Federal fund.

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