What is included in VHI for dentistry in 2021: pros and cons of the policy

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A beautiful smile is something that many people dream of for many years, or even their entire adult life.

However, the cost of correcting malocclusion using braces may exceed the financial capabilities of many patients.

The article will provide examples of the possibility of free bite correction, as well as methods of treatment at minimal cost.

Compulsory medical insurance policy: what rights does the patient have and what can he count on in the field of dentistry?

All Russian citizens have access to free dentistry under the compulsory medical insurance policy. This document of compulsory health insurance gives the right to receive a large list of services in budgetary municipal institutions and institutions. And this is really a way out for those who are neither ready nor able to spend money on expensive medical procedures in private clinics. Today we will analyze in detail what an ordinary patient can count on with this paper in hand.

Are fillings different?

In most cases, doctors in public clinics place fillings from simple cement mixtures. They are of good quality, durable and low cost. At the same time, they contain toxic substances. That's why many people choose paid materials.

The difference between paid and free fillings is quality. In the production of the former, modern high-quality materials are used, which have a long service life and do not create discomfort in the oral cavity. It is not necessary to install an expensive filling; you can choose a budget option among them. At that time, free ones are gradually erased.

During treatment, the specialist will offer several filling options. Among them, you can choose the option that suits the patient in terms of quality and cost.

Important! A seal supplied under a compulsory medical insurance policy has a 1-year warranty.

What is the document

An insurance policy is an official document confirming the fact of insurance of a citizen. It gives the right not only to dental treatment and free solutions to dental problems, but also the opportunity to receive medical care in any public clinics, regardless of their focus (therapy, cardiology, surgery, and so on). The scope of services provided is established by the territorial insurance program.

In appearance, the document looks like paper of a certain color (depending on the insurance company). Has a bar code and also a seal. More modern examples are small laminated cards with a microchip.

Important! In fact, nothing is free in the world, because public sector doctors also need to be paid a salary for the work they perform. Simply, if there is an insurance document, the patient is treated not at his own expense, but at the expense of government contributions to clinics, carried out through insurance companies from the regional compulsory medical insurance fund.

Dental treatment under a medical policy is today available to every citizen of the Russian Federation who resides in the country legally. The right to free medical care is granted regardless of age, type of employment, form of registration (permanent, temporary).

To receive the paper, you need to submit an application, as well as a passport and pension certificate (SNILS) to the insurance company. Within 14 days after your application, you will be given a document of the established form.

What services are included in insurance in 2019

According to Federal Law No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation,” a citizen who has a compulsory health insurance policy can count on receiving free medical services. These include:

• emergency help;
• outpatient studies;
• inpatient care;
• medical consultation;
• surgical intervention;
• diagnosis of the disease.

Patients of dental clinics also have the right to free medical care.

The list of dental services for children under compulsory medical insurance is quite extensive.

However, it does not apply to all types of services; for example, to get braces for a child, you will need paid treatment, but the installation of a plate is provided free of charge.

The list of dental services for children under compulsory medical insurance includes the following:

• the doctor's consultation;
• prevention and treatment of diseases (gingivitis, caries, pulpitis, periodontitis, abscess);
• installation of a seal;
• removal of tartar;
• surgical intervention (removal of teeth, foreign bodies from dental canals, soft tissue operations);
• jaw realignment;
• radiography;
• physiotherapy;
• orthodontics with removable products;
• remineralization of teeth;
• silvering of teeth.

The medical procedure is determined by the dentist. There are times when you need to go through several specialists. To do this, the doctor writes a referral and, based on the conclusion, makes decisions about further treatment.

In addition to free pediatric dentistry services under compulsory medical insurance, some consumables are provided free of charge:

• filling cement;
• polishing paste;
• arsenic;
• brush for cleaning teeth;
• consumables (dressing materials, bandages, cotton wool, etc.);
• anesthesia (Novocaine, Lidocaine, Trimecaine).

The specialist will definitely tell you what material he can offer for treatment, and the patient will decide for himself whether he should agree to the free option.

Where can I get dental services?

Dental services under the policy can be obtained in all municipal clinics in the country, as well as in some private institutions. Where can I find clinics that provide free services? This can be done on the website of the insurance company that issued and issued the document to you.

As a rule, the patient is assigned and registered at the medical center near which he lives. If you have a document, you cannot be denied service even if you have a residence permit in one city and live in another.

On a note! Today, many people prefer to join private dentistry, where they cooperate with insurance companies and accept patients under compulsory medical insurance. Why is this more convenient? Private centers have no queues and have the most modern equipment. True, here for such patients the hours and times of appointment may be limited, since doctors only accept patients if they do not have scheduled paid visits.

What happens if you do not have such a policy? In government agencies, regardless of your registration, you will be refused service. True, if the situation is critical and life-threatening, then doctors must still provide emergency assistance.

Which clinics accept patients under compulsory medical insurance?

An insured patient can go to the medical institution to which he is attached. But there are exceptions to the rules. In case of an acute condition, for example, pulpitis or periodontitis, you can seek emergency help at any clinic, regardless of your place of registration or residence.

The insurance also applies to some private offices, but their number is small. It is not profitable for them to work under compulsory medical insurance, since the insurance amounts are quite meager and do not cover all treatment costs. The policy is valid only in those private offices that participate in the state insurance program and are partners of the insurance company. This is the only way to be reimbursed for treatment.

A list of all institutions where you can get free dental care, including getting a light filling, is displayed on the compulsory medical insurance website. You can also check this information with your insurer by phone. The insurance company is a consultant on all issues that arise.

Important! To receive free treatment in a private clinic, you must become a patient in advance, otherwise you will have to pay.

It's easy to do. You need to go through the following procedure:

1. Select a suitable clinic from the register on the website.
2. Contact the registry office for attachment, taking with you all the necessary documents - passport and compulsory medical insurance policy.

Then you can make an appointment with the dentist. In emergency cases, assistance is provided without prior registration, as an exception.

Note. If the chosen clinic is not suitable, you can change it. But such a procedure is available no more than once a year.

To apply for treatment outside your place of residence, you must write an application addressed to the manager. The signed document must be taken to the insurance company.

In case of poor-quality care, the policy owner has the opportunity to complain to the insurer. Since the insurer pays for treatment, it monitors the quality of the services provided.

Health insurance is very important. According to the policy, you can not only install light fillings, but in general treat your teeth for free. But it’s worth knowing the exceptions when you have to pay. Information awareness is a must.

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Services under the compulsory medical insurance policy: what is required and what is not

Let us consider in detail the list of services that can be obtained under compulsory medical insurance in dentistry in 2020:

• examination, consultation and diagnostics from doctors in various fields of dentistry: therapist, surgeon, orthopedist and orthodontist,
• treatment of caries, pulpitis and periodontitis, gingivitis and periodontitis, installation of fillings,
• treatment and healing of jaw fractures,
• removal of mineralized plaque mechanically,
• tooth extraction, treatment of alveolitis, cysts, abscesses and pericoronitis,
• radiography: only targeted two-dimensional images can be taken free of charge,
• physiotherapeutic procedures,
• enamel remineralization procedures, orthodontic bite correction with plates and production of temporary stamped crowns for children.

It must be emphasized that to carry out manipulations free of charge, doctors use exclusively domestically produced materials.

And here is a list of what is not covered under the compulsory medical insurance policy in dentistry:

• installation of light-curing fillings, pins,
• use of imported materials and glass ionomer cements,
• surgical methods of treating periodontal tissues (curettage, tissue regeneration, osteoplastic surgery, vestibuloplasty),
• tooth-preserving operations (cystectomy, root apex resection),
• prosthetics, dental implantation,
• orthodontic bite correction using braces, mouth guards and other devices,
• imported anesthesia, sedation and anesthesia,
• teeth cleaning using ultrasound and Air-Flow, fluoridation,
• whitening,
• computed tomography and other types of 3D studies.

Important! Some services, for example, preferential prosthetics, are available only to certain categories of citizens. But again, it is important to understand that to receive them you need to collect the necessary papers, stand in line at the relevant social services and wait. In addition, only prostheses made from inexpensive materials - metal, acrylic, nylon - can be supplied free of charge. Who is eligible for the service and how to get it? More details about this in the feature article on the website.

Is a Light Curing Filling Included in the Compulsory Medical Insurance in 2020?

Good afternoon I am a dentist, I work in a state clinic, and the question has arisen: our people want it for free and excellently. I remember hearing somewhere that there is a law or an application, I don’t remember exactly, that legally we can offer a patient at a free appointment under compulsory medical insurance a filling, for example, a light-curing one, which is in no way issued by the clinic and is not paid for from compulsory medical insurance funds with their additional payment, respectively purchased at your own expense.

The seal is sold twice

On the issue of the legality of the actions of officials, you always have the right to clarify or make an official request and receive an answer to it within the time limits established by law to the management of the clinic, the municipal health department, or the territorial department for compulsory medical insurance. This also applies to the issue of pricing. In addition, it should be understood that the current system in the Russian Federation for the provision of free medical services is regulated, in particular, by territorial admission standards for certain medical services per day, month, etc.

Poor environment, poor nutrition, insufficient consumption of natural products, deficiency of important vitamins and minerals in the body, improper oral hygiene, the presence of chronic diseases and genetic predisposition are just some of the reasons that bring a patient to the dentist’s office. At the same time, it is important for a person to receive high-quality treatment that will help eliminate pain, restore aesthetics to the smile, normalize chewing functions and restore the anatomical shape of the tooth.

This is interesting: Will children's kits be provided on train 35 in 2020?

What to pay attention to

It is important to know that where treatment is provided free of charge under compulsory medical insurance, additional paid services are also provided. In many public dentistry, doctors have a list of not only domestic, but also paid imported materials, and carry out procedures for which they will then have to pay.

So that the news about the need to pay for treatment at a municipal clinic does not come as a shock to you, check with specialists in advance whether the service you need is included in the list of free services approved by the insurance program in the region. If the doctor offers any additional manipulations, then do not hesitate to clarify whether it is paid or free.

It should be taken into account that sometimes situations arise when it is better to pay extra for materials than to carry out treatment completely free of charge. Let's give a few examples.

Wisdom teeth removal

If you need to remove a wisdom tooth, then if you have a compulsory medical insurance document and want to be treated, you will be given a domestic anesthetic for free. However, it is far from certain that it will completely eliminate pain. Of course, in this case, it is better for the patient to pay for imported anesthesia, which has a minimum of side effects, high efficiency and a long exposure time.

Important! In free medicine, doctors often use painkillers such as Novocaine and Lidocaine. These drugs can cause individual intolerance, allergic reactions and side effects (especially in people with cardiovascular diseases, diabetes and hypertension, and elderly patients).

When filling

If you want to have your teeth filled with high quality, it is better to pay extra for the installation of an imported filling made from light-curing composites. Firstly, the material hardens very quickly, which means the patient has fewer restrictions after treatment. Secondly, the restoration looks more beautiful and natural in comparison with domestic phosphate cements, silicates and composites. Thirdly, imported materials will last several times longer, because they have high strength and wear resistance.

In the treatment of pulpitis

If you are undergoing dental treatment under a compulsory medical insurance policy, in particular for pulpitis, then it is important to understand what is included in the service. In government institutions, patients with pulpitis first kill the nerve using arsenic paste, which must be worn in the tooth for several days in a row.

Preparations containing arsenic are quite toxic; they should not be overexposed or swallowed. While they are in the tooth, many experience very unpleasant painful sensations. Often arsenic does not completely remove the nerve, and then during subsequent dental procedures you can feel severe pain.

Many patients who have had their teeth treated this way admit that they are left with a strong fear of dentists. If you do not want to encounter such problems, then it is easier, again, to pay extra for materials and treatment methods that allow you to remove the nerve in one visit to the clinic and without arsenic paste.

How can you be treated for free under compulsory medical insurance?

Free dentistry is not a myth, but a reality. Indeed, you can receive quality services. You don’t need to think that if you don’t have to pay, then the treatment is ineffective and the filling will fall out after a while. Filling material within the compulsory medical insurance is no worse than paid material. Of course, no one will offer imported seals, but domestic light seals are also of fairly good quality.

It is worth familiarizing yourself with the basic and territorial compulsory medical insurance program in advance, finding out what is paid and what is free, so that in case of conflict situations you have reliable information.

The rules for receiving free insurance assistance are prescribed by the Ministry of Health. You can’t just come to the clinic and get a free service. You need to select in advance a clinic that participates in the compulsory medical insurance program and join it.

All diagnostic and treatment procedures are determined exclusively by a specialist. You cannot require the installation of a light seal if, according to indications, it is necessary to install a metal or other one. The expenditure of public money is controlled by the state.

Article on the topic: Features of hospitalization at the MEDSI clinic under compulsory medical insurance

How to attach to a specific clinic

As mentioned above, admission under compulsory medical insurance is provided by any public dentistry. If you have chosen an institution where you want to undergo treatment, you must register there. To do this, you need to come directly to the clinic with a list of documents: insurance policy, passport or birth certificate of the child (if you need to register the child), SNILS.

The dentist will also ask you to write an application for registration and consent to medical intervention, after which they will create an individual card for you - from now on you have the right to receive the entire list of free services.

Is a light seal included in the policy?

According to compulsory medical insurance in 2020, filling material is free for policy holders. However, there are nuances. Before placing a light-curing filling, you need to clarify whether it is included in the compulsory medical insurance in 2019.

Domestic filling material is provided free of charge. This is cement. It is no worse than other materials, quite strong. Composite or metal may also be offered.

Light-curing fillings are modern and quite expensive. They are not only strong, but also do not differ in color from the tooth. They are installed using ultraviolet light, which promotes hardening.

According to compulsory medical insurance, a light filling, like a chemical filling, can be placed free of charge. This is stated in the Guidelines for paying for treatment through compulsory health insurance (Appendix 7). According to it, light seals are included in the compulsory medical insurance policy as a free service. The policy owner has the right to modern filling material.

However, the realities differ from the prescribed rules. Due to the lack of government money allocated for health insurance, light fillings are placed only when indicated, most often on the front teeth. In other cases, you should rely on paid imported reflective material. Installation of a photopolymer filling in a private clinic can be free if it is still under warranty.

Related article: Compulsory medical insurance policy and what documents are needed to obtain it

Important! Due to lack of money in the healthcare system, light-curing material is rarely purchased.

Light fillings are considered the strongest and most resistant to damage, which is why clinics offer them for a fee. It is illegal. If the doctor insists on paying for light filling material that is included in the compulsory medical insurance list, you must immediately call the insurance company directly from the dental office.

Making an appointment: nuances and features

State clinics accept appointments strictly. How to enroll in dentistry under compulsory medical insurance:

• you can go to the institution in person, taking your insurance and passport with you,
• you can get a coupon through the clinic’s website or a special electronic terminal installed in the dentistry lobby (not all medical institutions have such innovations, so check this point in advance),
• In some regions, registration through the government services portal is available.

In dentistry, where services are provided under the compulsory medical insurance policy, there is a large flow of patients, so getting an appointment on the day of treatment or even within a week after that can be problematic. In the best case, you can make an appointment only after 7 days. This point is very important to consider if you prefer to plan everything in advance.

Are there any dentists that work under the compulsory medical insurance policy without an appointment? The patient will be admitted out of turn at any institution only in critical condition, for example, with severe pain, acute purulent-infectious processes, high body temperature.

“Dental treatment under the compulsory medical insurance policy is a good option for patients who have minor problems (for example, initial caries), and also always undergo annual preventive examinations and monitor the condition of the oral cavity. In these cases, the savings are really real, moreover, they are absolutely justified. But if you have serious and advanced diseases, it often turns out that their treatment is not included in the list of free services. Or it is carried out extremely poorly - there are simply no materials and equipment in municipal dentistry. In this case, it is better to contact private clinics, because they benefit in terms of service and comfort, and are also equipped with the most modern devices for treatment,” says dentist-therapist Daria Varlamova.

Are there any benefits of compulsory medical insurance treatment for children?

Free pediatric dentistry under compulsory medical insurance is available to everyone. In this case, you can count on the following:

• the doctor will accept and perform a dental examination;
• eliminates the inflammatory process;
• will place a dental filling;
• removes plaque;
• will do splinting;
• cure diseases of the salivary glands;
• remove the tooth;
• will place the plate;
• will do an x-ray.

The advantage of treatment is that it is possible to cure dental diseases for free. However, such services include the most basic treatment options. You will have to pay for using imported materials.

Free dental treatment under compulsory medical insurance can also be of high quality.

Where to go with problems that require a quick solution

If your body temperature has risen, a purulent fistula has appeared, a flux has formed, an abscess has formed in the oral cavity, a cyst has begun to fester, or a jaw fracture has occurred, then know that there is emergency dentistry under the compulsory medical insurance policy. This means that you will be accepted at the clinic where you are assigned, without an appointment, that is, right on the day of your visit. The only thing is that you have to wait in a live queue, and the wait can last for several hours.

On a note! According to some studies, 35-40%[1] of citizens are not satisfied with the quality and procedure for the provision of free medical services under compulsory medical insurance. Is there a way out? You can improve the situation and significantly expand the list of services provided with the help of a Voluntary Medical Insurance (VHI) policy. Executing such a document will not be cheap (there are different programs), but the expenses will be worth it in the long run, plus you can get a tax deduction of 13% for the expenses. Some employers also issue VHI policies to their employees.

If dental problems that require an urgent solution arose during a business trip when you are in a foreign city, then you can contact any public dentistry. But it is better to first call the insurance company where the document was issued and find out the list of institutions with which it cooperates in a particular city.

“I hate our free healthcare. Once I had a really bad toothache, I just couldn’t stand it. The pills didn’t help at all... It was evening. We found out via the Internet that there is a dentist on duty, where they accept patients according to the policy even at night. Go. And what do you think: three hours in line, complete indifference of doctors... But that’s not all! The only treatment option that they offered, without even conducting a full examination, was tooth extraction!!!! That's it! Very unpleasant…"

Galina T, review from the dental portal gidpozubam.ru

Cost of VHI for dentistry in 2021 in the top 5 insurance companies

Some top insurance companies with high reliability ratings do not provide standard programs for individuals for VHI insurance with the option of dental services. For example, those insured who have dental treatment under the policy of VTB or SOGAZ either have corporate insurance or negotiate the terms of insurance individually. The table shows the prices of those organizations that have standard programs that include dental services.

What is included in free dentistry under the policy?

Every year the Government approves a territorial program of free dental care. Therefore, before contacting dentists in private clinics, it is advisable to familiarize yourself with the services that can be received free of charge.

Table of some free dental services included in the territorial compulsory medical insurance program:

In 2021, there is no need to pay for Russian-made medications and consumables (syringes, needles, dressings, napkins with clips).

For reference! Pensioners, disabled people and veterans can get prosthetics free of charge.

Often, clinics have different lists of free services. This depends on the financial health of the region. In addition, registers of medical institutions often do not correspond to the nomenclature approved by the Ministry of Health.

The procedure for receiving dental care under compulsory medical insurance

You can make an appointment with a doctor by calling a medical institution, coming to an appointment in person, or making an appointment through the website gosuslugi.ru.

5 steps to get free dental care:

1. Contact the clinic with your passport, individual personal account insurance number (SNILS) and insurance policy. On the basis of these documents, attachment to the clinic is carried out.
2. Clarify the scope of assistance provided under the territorial health insurance program.
3. If the service you need is included in the list, make an appointment with a doctor.
4. Sign an application to be assigned to the clinic and consent to medical intervention.
5. Call the insurer to find out the reasons for the refusal if the doctor refuses to treat for free.

If the service is not included in the list, you can contact another hospital or private clinic. Often help should be provided, but doctors refuse. Then patients are forced to defend their right to medical care. Sometimes it is enough to call the specialists of the company that issued the policy. If the appeal does not produce results, all that remains is to complain to higher management and go to court.

Thus, the Moscow City Court invalidated the contract for the provision of medical services and satisfied the plaintiff’s demands for damages (case No. 33-1265/2018). The court explained that the medical institution had no grounds to enter into an agreement with the patient to provide paid care. The patient did not receive treatment outside the scope of the compulsory health insurance program. According to the court's decision, the clinic must compensate the plaintiff for losses and moral damages.

If there is no registration or at a different address

The compulsory medical insurance policy guarantees receipt of medical care regardless of where the person is registered (Part 1 of Article 16 of the Law “On Compulsory Health Insurance”). The insured person has the right to choose a medical company and doctor. It’s better to sign up at a medical facility near your place of residence so that you don’t have any problems calling a doctor. It does not matter whether the temporary registration was issued in another region or not. The doctor is obliged to accept a patient who has a policy.

If you have moved, you need to contact your insurer to obtain a list of public clinics operating in this territory.

Often the refusal is due to the position of the hospital's chief physician and unwillingness to turn to another insurer to receive payment.

If they refuse to help you, there are two options:

1. Go to another hospital;
2. Go into conflict. You must submit a written request for a refusal to the management of the medical institution and complain to the health department.

The list of services that can be obtained differs. The policy gives the right to provide assistance throughout the Russian Federation within the framework of the basic compulsory medical insurance program. In the region where the policy is issued, the amount of assistance is determined by the territorial health insurance program. The territorial program cannot be less than the basic one.