OMS: what is guaranteed free of charge

Russian citizens are covered by compulsory medical insurance (OMS — obyazatelnoe meditsinskoe strakhovanie) under Federal Law No. 326-FZ. An OMS policy entitles you to free care under the state guarantee programme and your region's territorial programme: outpatient appointments, diagnostics, inpatient treatment, emergency care and some high-tech medical care.

Under OMS you may change your outpatient clinic and your health insurance organisation once a year and choose your doctor. If you are refused free care or asked to pay for something included in the programme, contact your health insurance organisation — its job is to protect the rights of the insured.

Where OMS falls short

In practice, patients face other issues:

  • waiting for an appointment with a specialist or for a test;
  • the need for a GP referral at every step;
  • a limited choice of clinics near home or work;
  • dental care in a basic scope;
  • service: appointment times, home visits at a convenient time.

DMS does not promise "better treatment", but it saves time and gives you choice. That is the main argument for a policy.

What DMS gives you

  • Appointments with specialists and diagnostics without long waits — at clinics in your programme.
  • Care organised through the insurer's assistance desk: you are booked in and tests are approved.
  • Dental care, home visits, private ambulance — if included in the programme.
  • Planned hospitalisation at chosen hospitals.
  • Telemedicine — online consultations.

For details on how programmes work and how to use a policy, see How DMS works.

Limitations to be aware of

Choosing a DMS policy is not easy. Budget programmes are designed for healthy people and contain limits:

  • a limited number of appointments with certain specialists and procedures;
  • expensive tests only with the insurer's approval;
  • exclusions: exacerbations of chronic diseases, cancer, pregnancy and a number of other conditions (depending on the rules);
  • a health questionnaire and possible refusal of cover for individuals.

People who buy a policy when they already have health problems often find that those very problems are excluded. That is why DMS works best when arranged in advance rather than at the moment of illness.

Another point is the list of clinics. The insurer may change it during the year, so check how this is done and what replaces a clinic that leaves the programme.

Who really needs DMS

  • Families with young children — frequent paediatrician visits and home calls.
  • Busy people for whom waiting time is worth more than the cost of the policy.
  • Company employees — if your employer offers DMS, use it; you can often add relatives at your own expense at the corporate rate.
  • Foreigners and expats who are not eligible for OMS or prefer clinics with English-speaking staff.

If you rarely fall ill and are happy to use OMS, a full policy may not pay off. In that case consider the alternatives.

Alternatives and ways to save

Reduced programmes

You can take outpatient care and telemedicine only, without inpatient cover, or dental care only. Such policies are noticeably cheaper.

Deductible

If you pay part of the cost of each visit, the premium goes down.

Group contract

Corporate contracts are usually cheaper per person than individual ones. Ask your employer whether relatives can be included.

Critical illness insurance

If your main concern is a serious diagnosis rather than colds, look at critical illness insurance: it pays for treatment or pays out a lump sum when a serious illness is diagnosed.

Tax deduction

For a DMS policy paid for yourself or close relatives, Russian tax residents can claim the social tax deduction within the overall limit of RUB 150,000 per year. Condition: the contract covers only medical services and the insurer is licensed.

Conclusion

DMS is neither a replacement for OMS nor a luxury — it is a tool that buys you time and choice. A policy makes sense if you value quick access to doctors, have children, or your employer partly pays for the programme. Before buying, compare several offers with the same list of clinics. Polis Re specialists will help you choose a programme — submit a request or explore the DMS section.