" № 9/2012

Regional authorities allocate funds to medical institutions for medical examinations of certain categories of citizens. It is important to follow the order of spending such funds. Otherwise, officials may decide that funds are being misused.

When is the screening

According to article 46, paragraph 4 federal law dated November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation”(hereinafter - Law No. 323-FZ), medical examination is a set of measures (examinations), including a medical examination by doctors of several specialties, in relation to certain groups of people.

The procedure for medical examination is prescribed by law and the financing of this event is fixed in relation to, for example:

- working citizens (Order of the Ministry of Health and Social Development of Russia dated February 4, 2010 No. 55n "On the procedure for conducting additional medical examinations for working citizens", Decree of the Government of the Russian Federation dated December 31, 2010 No. 1228);

– orphans and children in difficult life situation(Decree of the Government of the Russian Federation of December 31, 2010 No. 1234 “On the procedure for providing subsidies from the budget of the Federal Compulsory Medical Insurance Fund to the budgets of territorial compulsory medical insurance funds for medical examinations of orphans and children in difficult life situations staying in stationary institutions”) ;

- employees of the internal affairs bodies (Decree of the Government of the Russian Federation of December 30, 2011 No. 1232 “On the procedure for providing employees of the internal affairs bodies of the Russian Federation, certain categories of citizens of the Russian Federation dismissed from service in the internal affairs bodies, and their family members with medical care and their sanatorium- resort provision ");

- military personnel and their families (Article 25 of Law No. 323-FZ).

The procedure for allocating subsidies

Subsidies are provided within budget appropriations provided by the Federal Law on the budget of the Federal Compulsory Medical Insurance Fund for the next financial year and the planned period for medical examination.

Funds are allocated monthly to the Territorial Compulsory Medical Insurance Fund (TFOMS) based on the number of citizens undergoing medical examination, in accordance with the previously approved program of the corresponding subject of the Russian Federation and the cost standard for its implementation.

To do this, the territorial fund submits to the federal fund a schedule for conducting medical examinations of citizens for the current financial year, approved by the authorized body executive power subject of the Russian Federation, on time and in the form established by the federal fund.

The funds are transferred to a separate account opened by the territorial fund in the subdivision of the settlement network of the Central Bank of the Russian Federation to financially cover the costs of medical examination. And then these funds are transferred to medical institutions.

They have the right to use the funds received solely for the purpose of medical examination. For this, medical institutions maintain registers of invoices for payment of expenses associated with the medical examination, in the manner established by the federal fund, and then monthly, until the 10th day of the month following the reporting one, submit registers of accounts to the territorial fund.

Spending funds received

Funds received medical institutions, are sent to:

- wages of medical workers involved in the medical examination (with the exception of district physicians, general practitioners (family) practitioners, nurses of these categories of doctors who receive incentive payments for additional medical care);

- purchase of consumables necessary for medical examination;

– payment for the services of third-party medical organizations licensed to carry out the missing types of work (services), with which contracts must be concluded.

The lack of funds required according to the register of invoices to pay the expenses associated with the medical examination in the previous month is reimbursed in the current month within the subsidy credited in the previous months in the form of an advance.

Medical organizations, in the manner and in the forms established by the federal fund, keep records of citizens who have undergone medical examinations and submit relevant reports to territorial funds.

Powers of the regions

State authorities of the constituent entities of the Russian Federation are empowered to expand the list medical services(including within the framework of medical examination). But then Additional services they also finance.

As an example of the initiative of the regional authorities, one can cite additional measures for the medical examination of the Moscow Region (order of the Ministry of Health of the Moscow Region dated February 9, 2010 No. 86 “On improving the work of conducting medical examinations for disabled people and participants in the Great Patriotic War”) or St. Health of St. Petersburg dated March 17, 2010 No. 109-r “On additional measures for in-depth dispensary examination of disabled people, veterans, spouses of dead (deceased) disabled people and participants in the Great patriotic war 1941–1945 and persons awarded with the badge “Inhabitant of besieged Leningrad””).

Important to remember

For medical examinations of certain categories of citizens, medical institutions may be allocated funds from the Compulsory Medical Insurance Fund. However, they must be accounted for.

Reply from 04/03/2014 18:32

Natalia, in order to financially support the expenditure obligations of the constituent entities of the Russian Federation arising from the exercise of the powers delegated to them to organize compulsory medical insurance in the territories of the constituent entities of the Russian Federation, in the budget of the Federal Compulsory Medical Insurance Fund for 2013 and the planned period of 2014 and 2015. subventions are provided. The calculation of the amount of subventions provided from the budget of the FFOMS to the budgets of the territorial funds of compulsory medical insurance is carried out in accordance with Decree of the Government of the Russian Federation of 05.05. FFOMS budget provided for the following purposes:
- for financial support of measures for medical examination of certain groups of the population, dispensary observation, preventive medical examinations in accordance with the procedures established by the Ministry of Health on the basis of Decrees of the Government of the Russian Federation of December 31, 2010 N 1228, of December 31, 2010 N 1234;
- for the remuneration of medical personnel as part of the financial support for the provision of additional medical care provided by district general practitioners, district pediatricians, general practitioners (family doctors), district nurses of district general practitioners, district pediatricians, nurses of doctors general practice (family doctors) in accordance with Decree of the Government of the Russian Federation of December 29, 2009 N 1110;
- for the implementation of cash payments to medical personnel of feldsher-obstetric stations, doctors, paramedics and emergency nurses in accordance with Decree of the Government of the Russian Federation of December 29, 2009 N 1111.

Surcharges for medical examinations carried out by medical workers participating in its conduct. They are made in accordance with the above Decrees of the Government of the Russian Federation N N 1228, 1234. The specific amounts of these payments are not established by these regulations. Medical institutions spend the allocated funds on remuneration of medical workers involved in additional medical examinations of working citizens (with the exception of district general practitioners, general (family) practitioners, district nurses of district general practitioners, nurses of general (family) practitioners) , at its own discretion, that is, the amount of payments aimed at remuneration can be any. In addition, it is allowed to spend the allocated funds:
- for the purchase of consumables necessary for additional medical examination of working citizens;
- for the remuneration of medical workers of medical organizations involved in additional medical examinations of working citizens, and the purchase of consumables in accordance with contracts concluded by medical organizations that carry out such medical examinations with medical organizations that have licenses to perform (render) the missing types of work (services) ).
Additional payments to medical staff of feldsher-midwife stations, doctors, paramedics and nurses of emergency medical institutions. They are carried out in accordance with the Rules approved by Decree of the Government of the Russian Federation N 1111 (hereinafter - Rules N 1111).
The amount of additional payments is determined by paragraph 2 of Rules N 1111 and per month is: for a doctor - 5000 rubles, for a paramedic (midwife) - 3500 rubles, for nurse- 2500 rub. (with the provision of guarantees to medical workers established by the Labor Code of the Russian Federation).
Additional payments to medical personnel as part of the financial support for the provision of additional medical care provided by district general practitioners, district pediatricians, general practitioners (family doctors), district nurses of district general practitioners, district pediatricians, nurses of general practitioners ( family doctors). These payments are made in accordance with the Rules approved by Decree of the Government of the Russian Federation N 1110 (hereinafter - Rules N 1110).
The amounts of these additional payments are established by clause 2 of Rules N 1110:
- for district general practitioners, district pediatricians, general practitioners (family doctors) - 10,000 rubles. per month;
- for district nurses of district general practitioners, district pediatricians, nurses of general practitioners (family doctors) - 5000 rubles. per month.
All the above payments to medical workers are made taking into account district coefficients to wages established by the decisions of the bodies state power subjects of the Russian Federation or federal government bodies of subjects of the Russian Federation. Funds are allocated taking into account deductions for insurance premiums during off-budget funds and compulsory social insurance against industrial accidents and occupational diseases. In addition, funds are provided for providing medical workers with guarantees established by Art. 114, part 4 of Art. 139, art. Art. 167, 183, 187 of the Labor Code of the Russian Federation.
Additional payments to doctors and nurses involved in the implementation of measures regional programs modernization of health care in the constituent entities of the Russian Federation to introduce standards of medical care and increase the availability of outpatient medical care, including that provided by medical specialists. They are regulated by the normative acts of the constituent entities of the Russian Federation. As an example, let us cite the Order of the Moscow Department of Health of May 30, 2013 N 538 "On incentive payments to medical specialists and specialists with secondary medical education participating in the implementation of measures to increase the availability of outpatient medical care and the quality of services provided. "This regulatory act for the subject of the Russian Federation approved:
- Guidelines for registration in 2013 labor relations between specialist doctors, specialists with secondary medical education involved in the implementation of measures to increase the availability of outpatient medical care, and medical organizations providing primary health care (hereinafter - the Methodological Recommendations);
- recommended forms of an additional agreement to an employment contract on increasing the amount of work performed by a medical specialist.
So, in accordance with paragraph 6 of the Methodological recommendations, the amounts of additional payments are:
- for specialist doctors, with the exception of district general practitioners, general practitioners - at least 5,000 rubles;
- specialists with secondary medical education, except for nurses of district general practitioners, general practitioners involved in the implementation of measures to increase the availability of outpatient medical care for children - at least 3,000 rubles.
At the same time, the total amount of expenses for the payment of an incentive bonus, established for all categories of employees as part of the ongoing activities for 2013, should not exceed the amount of funds allocated to the healthcare institution in the reporting year for these purposes.
On a monthly basis, state healthcare institutions analyze the performance of an additional amount of work for the previous reporting month by medical specialists and specialists with secondary medical education on the basis of an additional agreement to the employment contract in accordance with the Performance Indicators and Indicators approved by the Order of the Ministry of Health and Social Development of Russia dated February 21, 2011 N 145n.
The analysis of the performance of work is carried out on a commission basis with the obligatory keeping of the protocol of the commission and the submission of the actual amounts of material incentive payments for approval to the head physician of the medical organization.
For the performance of the additional amount of work provided for by the supplementary agreement, the employer is recommended to establish an incentive bonus for the employee for a period of up to one year, the amount of which is specified in the supplementary agreement and the order establishing the bonus. The stimulating bonus is not taken into account when calculating the bonuses and additional payments provided for by the relevant laws and other regulatory legal acts.
The employer should establish in an additional agreement a condition on the possibility not to charge an incentive bonus for the months in which there were cases of non-fulfillment by the employee due to his fault of the additional amount of work assigned to him.

Hello! I would like to clarify whether the manager should pay for periodic medical examinations if the employee is required to undergo medical examinations this year

There are 3 different concepts to be distinguished here. examination as such, medical examination of citizens and periodic medical examinations of employees working with harmful factors and /teachers-teachers are included in the group of persons for whom mandatory periodic medical examinations are established/.

The fact is that during the medical examination and periodic medical examination, doctors make all kinds of reports different shapes although, in fact, many of the doctors who pass the teacher, both during the medical examination and the periodic medical examination, do the same manipulations - examinations, but the doctors write different reports in accordance with the Orders of the Ministry of Health on the equivalence of medical examinations and periodic examinations, it was not possible to find official documents: something was explained in the letter -

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
LETTER dated August 29, 2013 N 14-2/10/2-6432

Item 3 of the Procedure for routine inspection.3. Preventive medical examination is carried out 1 time in 2 years.In the year of the medical examination, a preventive medical examination is not carried out..

Employees engaged in work with harmful and (or) dangerous production factors, and employees engaged in certain types of work, which, in accordance with the legislation of the Russian Federation undergo mandatory periodic medical examinations,

are not subject to preventive medical examination .

Lists of harmful and (or) dangerous production factors and work, during the performance of which preliminary and periodic medical examinations (surveys) are carried out, and the procedure for conducting preliminary and periodic medical examinations(surveys) of workers employed in hard work and at work with harmful and (or) dangerous working conditions, are presented in the annexes to the order of the Ministry of Health and social development Russian Federation t April 12, 2011 N 302n.

thus, in the year of medical examination, exemption from professional examination is provided for, but teachers are required to undergo periodic medical examination according to Order N 302n for teachers once a year. this inspection in accordance with Article 213 of the Labor Code of the Russian Federation is paid by the employer in accordance with clause 6 of Order No. 302 N -

Responsibilities for organizing preliminary and periodic examinations of employees are assigned to the employer<1>

Appendix to the order of the Ministry of Health of the Russian Federation of December 3, 2012 N 1006n

Clinical examination is carried out with the informed voluntary consent of the citizen or his legal representative. A citizen has the right to refuse to conduct a medical examination in general or from certain types medical interventions included in the scope of clinical examination, in accordance with Article 20 of the Federal Law of November 21, 2011 N 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation."
Based on information about the passage of a medical examination by a citizen medical worker of the department (office) of medical prevention, the “Card of medical examinations (preventive medical examinations)” is filled out in the form approved in accordance with paragraph 11 of part 2 of article 14 of the Federal Law of November 21, 2011 N 323-FZ “On the basics of protecting the health of citizens in the Russian Federation".

Information about the medical examination and its results are entered by the general practitioner in the health passport, which is issued to the citizen. - his personal document

During a periodic examination - based on the results of the examinations, the medical organization, no later than 30 days after the completion of the periodic medical examination, summarizes the results of the periodic examinations of employees and, together with territorial bodies federal executive body authorized to carry out state control and supervision in the field of ensuring the sanitary and epidemiological welfare of the population and representatives of the employer, is the final act. This act is approved by the chairman of the medical commission, certified by the seal of the medical organization and drawn up in four copies, one of which is sent to the employer within 5 working days from the date of approval by the medical organization (clauses 44, 45 of the Order).

thus the main difference Dispensary is voluntary

Periodic medical check-up Mandatory procedure for the Teacher.

There is nothing for you to unequivocally and legally motivate your refusal to the medical institution from passing by teachers of the Periodic medical examination in the year of medical examination of CITIZENS.

Labor legislation does not contain such a thing as medical examination in the Labor Code of the Russian Federation there is only a rule on Periodic medical examinations IF THE EMPLOYEE DOES NOT pass mandatory medical examination You must remove him from work.

Every year the Ministry of Health and Social Development allocates budget resources for financial support of additional medical examination of working citizens. What is meant by dispensary? Are employees required to pass it? Can an employer take disciplinary measures against employees who refuse to undergo medical examination?

What is meant by dispensary?

There is no definition of dispensary in labor law. If we turn to dictionaries, then it is understood as a system of medical measures carried out medical institutions for the purpose of timely diagnosis, treatment and prevention of diseases. However, in practice, employees quite rarely undergo such a medical procedure - in particular, because employers do not know what rules it is carried out under.

Of course, clinical examination could be attributed to the types of medical examinations, which, by virtue of Art. 213 of the Labor Code of the Russian Federation, the employer is obliged to carry out for those employed in heavy work, work with harmful and (or) dangerous working conditions (including underground work), work related to traffic.

However, medical examination of workers is not a periodic medical examination in the sense in which this concept is used in the Labor Code, since the procedure for its implementation is determined by the Ministry of Health and Social Development.

Yes, and their goals are different: the inspection is carried out in order to determine the suitability of employees to perform the assigned work and prevent occupational diseases, and medical examination is aimed at early detection and prevention of diseases, including socially significant ones (diabetes mellitus, tuberculosis, oncological and cardiovascular diseases). , diseases of the musculoskeletal system), which are the main cause of death and disability of the able-bodied population of the Russian Federation.

The question of who exactly is subject to medical examination is answered only by the rules for granting subsidies from the budget of the federal compulsory medical insurance fund to the budgets of territorial compulsory medical insurance funds for additional medical examination of working citizens, approved by Decree of the Government of the Russian Federation of December 31, 2010 N 1228.

Paragraph 2 of these rules establishes that citizens without age restrictions who work in organizations regardless of their organizational and legal form and form of ownership, including workers employed in work with harmful and (or) dangerous production factors, insured in the system compulsory health insurance.

The procedure for additional medical examination

Additional medical examination is carried out by medical institutions participating in the implementation of programs of state guarantees for the provision of free medical care to citizens of the Russian Federation, and involves:

1. Examination of an employee by specialist doctors:

- a general practitioner (a local general practitioner (family doctor));

- an obstetrician-gynecologist;

- a surgeon;

- a neurologist;

- an ophthalmologist.

2. Laboratory and functional studies:

- clinical blood and urine tests;

- blood chemistry;

— blood for tumor markers (for workers over 45 years old);

- electrocardiography;

- fluorography;

- mammography (for women over 40).

By virtue of clause 5 of the Procedure, working citizens are subject to additional medical examination, as well as those employed in work with harmful (dangerous) working conditions, regardless of the timing of in-depth medical examinations, and who underwent medical examination in 2007, if they were not taken under dispensary observation as a result of the identified diseases.

An outpatient card is filled out for an employee who comes to a medical facility to undergo additional medical examination at the registry office and is transferred to the medical prevention office or to another unit that is entrusted with the functions of conducting medical examination. There, the so-called worker's health passport is filled out and sent to specialist doctors.

After examining the employee, the general practitioner, taking into account the conclusions of all specialist doctors involved in the additional medical examination, and the results of laboratory and functional studies, determines (in order to plan further activities) a group of health status. There are five of them.

Group I - practically healthy citizens who do not need dispensary observation. A preventive conversation is held with them and recommendations are given for healthy lifestyle life - on healthy eating, physical activity, maintaining optimal body weight, the dangers of smoking.

Note. If the employee is registered at the place of residence in one subject of the Russian Federation, and labor activity carries out in another, he can undergo additional medical examination either at the place of work or at the place of residence (clause 5 of the Procedure).

Group II - citizens at risk of developing the disease, in need of preventive measures. For them, the total cardiovascular risk is assessed, other risks of diseases depending on the identified risk factors, recommendations are given for the prevention of diseases.

Group III - those who need additional examination on an outpatient basis to clarify (establish) a diagnosis for a newly diagnosed chronic disease or in the presence of an existing chronic disease, as well as those who need treatment on an outpatient basis (acute respiratory infections, influenza and other acute diseases, after treatment of which occurs recovery).

Group IV - those in need of additional examination and treatment in a hospital for diseases identified during additional medical examination. These workers are sent for planned hospitalization.

Group V - citizens with newly diagnosed diseases or being observed for a chronic disease and having indications for the provision of high-tech medical care. In this case, the medical documentation of the employee is sent to the executive authority of the constituent entity of the Russian Federation in the field of healthcare to make a decision on sending the citizen to a healthcare institution to provide high-tech medical care.

Employees assigned to health status groups I and II are recommended to visit health centers for further recommendations from medical specialists on a healthy lifestyle (clause 8 of the Procedure). Those assigned to III-V groups of health status, depending on the identified diseases, an individual treatment program is drawn up, if necessary, dispensary observation is established at the place of residence.

How to send employees for medical examination?

Source: http://prom-nadzor.ru/content/dispanserizaciya-rabotnikov

Medical examination of employees - All about personnel

Often in the media we see news that once again a campaign for the medical examination of working citizens begins. Indeed, on the basis of the Federal Law of 21.11.

2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (hereinafter referred to as the Basics of protecting the health of citizens), prevention in the field of protecting public health is provided by a set of measures, including without fail includes medical examination and dispensary supervision.

Every year, the state allocates considerable funds for these events, so today we will tell you what medical examination is, who should undergo it, and whether employees who refuse to undergo medical examination can be disciplined.

Dispensary - what is this event?

Prior to the adoption of the Fundamentals of Protecting the Health of Citizens, definitions of clinical examination could only be found in dictionaries. Now Art. 46 of the normative act, it is determined that medical examination is a set of measures, including a medical examination by doctors of several specialties and the use of the necessary examination methods carried out in relation to certain groups of the population in accordance with the legislation of the Russian Federation.

Here it is also necessary to define dispensary observation, which is a dynamic observation of the state of health of persons suffering from chronic diseases, functional disorders, other conditions, for the purpose of timely detection, prevention of complications, exacerbations of diseases, other pathological conditions, their prevention and medical rehabilitation of these persons, carried out in the manner established by the authorized federal executive body.

Note! Part 3 of Art. 254 of the Labor Code of the Russian Federation provides for the preservation of a woman's average earnings at the place of work for the duration of the dispensary examination. The regulation on the organization of medical examinations for pregnant women and puerperas was approved by Order of the Ministry of Health and Social Development of the Russian Federation of March 30, 2006 N 224.

Quite often, employers confuse medical examinations with periodic medical examinations. However, there is a significant difference between them - the purpose of the event. Medical examinations are carried out to determine the suitability of workers for the performance of assigned work and the prevention of occupational diseases. Clinical examination is carried out for early detection:

Chronic non-communicable diseases (conditions) that are the main cause of disability and premature death of the population;

Risk factors for the development of diseases (high blood pressure and blood glucose, low physical activity, etc.);

Consumption of narcotic drugs and psychotropic substances without a doctor's prescription.

Note. The funds received by medical organizations for additional medical examinations of working citizens are directed by them to pay for the work of health workers involved in such medical examinations (with the exception of district general practitioners, general practitioners (family doctors), nurses of district general practitioners, nurses of doctors general practice (family doctors)).

In addition, during the clinical examination, the necessary preventive, therapeutic, rehabilitation and health measures are determined for citizens with identified chronic non-communicable diseases or risk factors for their development, citizens with other diseases, healthy citizens. Groups of dispensary observation of citizens with identified chronic non-communicable and other diseases, with high and very high total cardiovascular risk are also compiled.

As you can see, clinical examination is a much more serious procedure than a periodic medical examination.

Who is subject to screening?

The answer to this question can be found in the regulations. In particular, on the basis of Decree of the Government of the Russian Federation of December 31, 2010 N 1228, citizens without age restrictions working in organizations regardless of their organizational and legal form and form of ownership, including workers employed in work with harmful and (or) dangerous production factors insured in the system of compulsory health insurance.

In addition, non-working citizens and students studying in educational institutions in face form.

The order of the medical examination

The procedure for conducting medical examinations was approved by Order of the Ministry of Health of the Russian Federation dated 03.12.2012 N 1006n. It has not yet entered into force, but the regions have already developed their medical examination programs based on it.

Clinical examination is carried out every three years in the following age periods: 21, 24, 27, 30, 33, etc. And the invalids of the Great Patriotic War, persons awarded the sign “Inhabitant of besieged Leningrad” and recognized as disabled due to a general illness, labor injury and other reasons, undergo medical examinations annually, regardless of age.

Additional medical examination of working citizens is carried out by medical organizations participating in the implementation of programs of state guarantees for the provision of free medical care, which have a license to carry out medical activities.

What does dispensary include? The list of examinations by specialist doctors (medical assistant or midwife), research and other medical activities carried out as part of the medical examination depends on the age and gender of the citizen. Thus, the dispensary involves two stages.

The first stage - screening - is carried out for the purpose of primary identification and selection of citizens with suspected diseases and includes:

1. Survey (questionnaire) to identify chronic non-communicable diseases and risk factors for their development.

2. Anthropometry (measurement of standing height, body weight, waist circumference, calculation of body mass index).

3. Measurement of blood pressure, eye tonometry (for citizens 39 years of age and older), determination of total cholesterol and blood glucose; resting ECG (all at age 21, then for men over the age of 35, for women over the age of 45); examination by a midwife; fluorography of the lungs; mammography (for women aged 39 and older); analysis of blood and urine, ultrasound of the abdominal organs (for persons aged 45, 51, 57, 63 and 69 years).

4. Preventive appointment (examination, consultation) with a neurologist (for persons aged 51, 57, 63 and 69 years).

5. Reception (examination) of a general practitioner (family doctor) of healthy persons and persons with a diagnosed disease that does not require additional examination at the second stage of medical examination.

At the second stage, there is an additional examination and clarification of the diagnosis of the disease, preventive counseling. Also held:

Esophagogastroduodenoscopy (for persons over the age of 50 years in the presence of "gastroduodenal" complaints identified during the questionnaire and aggravated heredity for oncological diseases of the esophagogastic zone), etc.;

Examination (consultation) of an ophthalmologist, neurologist, surgeon, urologist, etc.;

Referral of the patient according to the identified indications to a medical organization providing specialized, including high-tech medical care, and to sanatorium treatment, individual or preventive group counseling (health school) in the department of medical prevention and health centers.

On the basis of information about the passage of a medical examination by a citizen, a medical worker of the department (office) of medical prevention fills in the "Card of registration of medical examinations (preventive medical examinations)". Information about the medical examination and its results is entered by the general practitioner in the health passport, which is issued to the citizen.

Mandatory medical examination for working citizens

Of course, no one will drag an employee by force to a medical organization to undergo medical examination. Moreover, it has been established that it is carried out with the voluntary consent of a citizen or his legal representative, on the basis of information provided by a health worker in an accessible form about the goals, methods of providing medical care, the risk associated with them, possible options for medical intervention, about its consequences, as well as about the expected results of medical care.

What should an employer do if his employee has expressed a desire to undergo medical examination? Is it possible to consider absence from work in connection with medical examination as absenteeism?

Note. A citizen has the right to refuse to conduct medical examinations in general or from certain types of medical interventions included in the scope of medical examinations.

By this issue there are two positions. Some experts believe that if an employer sent an employee to undergo medical examination, he cannot refuse, since he is obliged to periodically undergo a medical examination in certain cases. After all, Art.

213 of the Labor Code of the Russian Federation, it is established that for the period of passing a medical examination, the employee retains his place of work and average earnings, and by virtue of Art. 76 of the Labor Code of the Russian Federation, the employer has the right not to allow an employee who has not passed a medical examination to work.

Other experts believe that since the Labor Code of the Russian Federation does not mention the medical examination of employees and employers do not carry it out at their own expense, the obligation of employees to undergo medical examination has not been established.

But if the employee has independently expressed a desire to undergo medical examination, the employer is obliged to provide conditions for its passage (as medical examinations), as well as freely release the employee for this (Article 24 of the Fundamentals of Health Protection Legislation). Therefore, about any absenteeism or other violation labor discipline in the case of an employee undergoing a medical examination, there can be no question - provided that the obligatory medical examination is not fixed in the local normative act or employment contract.

Note! If the obligation to undergo medical examination is fixed in the collective or labor agreement, the employee is obliged to appear for additional medical examination.

Finally

Unfortunately, due to gaps in the legislation, at present, there are quite a lot of ambiguities for employers in the issue of medical examination: this is the registration of the absence of an employee at work during the period of medical examination, and the payment of this time, and its inclusion in the periods for calculating temporary benefits. disability, etc. An incentive mechanism for employers to be more willing to release staff for medical examination is not yet provided. However, we believe that it is in the interests of the employer to have a healthy team, so we recommend that you still meet the needs of employees who have expressed a desire to undergo a medical examination.

Source: http://info-personal.ru/bolnuchnuy-list/dispanserizatsiya-rabotnikov/

Medical examinations at the expense of the employer and employee: personal income tax and insurance premiums

Evgenia Dubkova, a leading expert of the Department of Small and Medium Business "My Business", analyzes in detail the issue of calculating personal income tax and insurance premiums on the amounts allocated by the company for mandatory medical examinations for employees and what to do if the medical examination was passed by the employee at his own expense, and later the employer reimbursed him costs

The employer must pay for mandatory medical examinations of employees at “his own expense”. If there is an agreement with a medical organization or you have issued VMI policies for employees, there are no taxation issues. But it happens that the employee (applicant) pays for the medical examination himself, and the employer compensates him for the costs. This raises many questions regarding the calculation of "salary" payments.

In addition, many employers are wondering: can medical examinations, which are so often reported to citizens by the media and local authorities, be equated with mandatory medical examinations? But first things first.

In cases stipulated by law, it is necessary to conduct medical examinations of employees at their own expense (by the way, this also includes mandatory vaccination of personnel). This is expressly stated in Art. 212 of the Labor Code of the Russian Federation.

Conditionally mandatory medical examinations can be divided into:

• preliminary (at employment);
• periodic (during operation).

Enter information about medical examinations in medical books workers.

To determine which jobs require medical examinations, be guided, in particular, by the Lists approved by the Order of the Ministry of Health and Social Development of Russia No. 302n dated April 12, 2011. They name such areas of activity as trade, hotel business, education, medicine (including pharmacy chains), etc.

In addition, regions can expand the list of professions subject to mandatory medical examinations. For example, the Ministry of Health sent for approval to the local authorities an Indicative List of Occupations Requiring Medical Books.

These are, for example, employees of organizations for the production, storage, transportation and sale of food products and drinking water, communal and household services population.

Is it necessary to pay for a medical examination for office workers who constantly work at a computer?

By general rule- No. It all depends on the results of a special assessment (attestation of jobs) or production control data. Rostrud believes that under optimal or permissible working conditions at the workplace, the employer is not obliged to organize medical examinations by the factor “electromagnetic field of the broadband frequency spectrum from a PC”. A similar opinion is shared by Rospotrebnadzor.

Is a trade organization obliged to pay for a medical examination of its accountant who does not contact the public?

Yes, I must. All trade workers must undergo mandatory medical examinations. This requirement is established without reference to specific types of trade and products sold. Therefore, it does not matter whether this or that specialist is in fact in contact with controlled products or the population.

At the time of the mandatory medical examination, keep the average salary for the employee (he is generally subject to both personal income tax and insurance premiums).

An employee who has not passed a medical examination should not be allowed to work.

"My business" warns: if the employee does not have a medical book or there are no records of a medical examination in it, the organization can be fined in the amount of 10 thousand rubles. up to 20 thousand rubles. or suspend activities for up to 90 days.

Is it possible to “count” the passage of the medical examination of the population in the passage of a mandatory medical examination?

No. These events have different goals and procedures for organizing them. Medical examinations are carried out to determine the suitability of workers for the performance of assigned work and the prevention of occupational diseases.

The purpose of medical examination: a cumulative assessment of the state of human health and the achievement of active longevity of the population. The employer must pay for the medical examination, because without confirming the “fitness” of the employee to perform the assigned work, he cannot be admitted to it.

Medical examination is paid by the state in the framework of the legislation on the Fundamentals of protecting the health of citizens.

The mechanisms for organizing these types of examinations (the list of examinations, analyzes, etc.) are different. Therefore, you should not assume that if an employee independently underwent a free medical examination, then a medical examination is not necessary for him.

Accordingly, the guarantees on the part of the employer in relation to employees undergoing a medical examination do not apply to cases where they undergo medical examination.

That is, you are not obliged to release the employee for such a “free” health check while maintaining the average earnings for the time of absence (unless, of course, your social package provides otherwise).

The employee paid for a medical examination - the employer compensated personal income tax and insurance premiums

On this issue, the controlling agencies (moreover, even within the framework of one structure - the Ministry of Finance of Russia) do not have a clear position.

So, in a letter dated February 8 this year, it is said that personal income tax must be withheld from the compensation of the employee's expenses for a medical examination. Officials are ready to do without tax withholding only if the employer pays for the medical examination. The mechanism, when the employee does this instead of the employer, and the employer only compensates for the costs, the department considers “outlawed”. In this case, compensation for expenses for a medical examination may not be subject to personal income tax not as compensation (clause 3 of article 217 of the Tax Code of the Russian Federation), but on the basis of another norm - clause 10 of art.

217 of the Tax Code of the Russian Federation, that is, as well as payment for a medical examination at the initiative of the employer. For this, however, certain conditions must be met. In particular, it must be paid at the expense of the funds remaining after paying corporate income tax. That is, this method will not improve the situation for employers-individual entrepreneurs and organizations in a special regime. The only "consolation" may be partial compensation of costs by paying financial assistance. It is not subject to personal income tax in the amount not exceeding 4000 rubles.

for the tax period (year).

However, Labor Code The Russian Federation does not specify exactly how the employer should pay employees for medical examinations.

Does not see violations in such payment and Rostrud. Moreover, according to this department, since the employer is obliged to organize a medical examination, his refusal to reimburse the employee's expenses is a violation of the law. It should be noted that earlier the Ministry of Finance also adhered to this position, indicating that such compensation to an employee does not essentially form his economic benefit and should not be subject to income tax. Moreover, quite recently, the financial department again repeated this position, which is beneficial for the employer and the employee, when responding to a private request.

AT arbitration practice judges generally support employers in their unwillingness to withhold personal income tax (see, for example, the Decree of the FAS of the North-Western District, the Decree of the FAS of the Moscow District).

The situation is similar with insurance premiums. In a letter dated February 8, the Ministry of Finance also indicated its position on the calculation of contributions to compensate for the costs of a medical examination.

Specialists of the financial department conclude: payments to reimburse the costs of a medical examination should be subject to insurance premiums. However, the arguments "against" such a position are the same. The Labor Code of the Russian Federation does not impose restrictions on this method of paying for a mandatory medical examination for employees. Accordingly, for this reason, such refunds do not lose their “statutory guarantee” nature, and therefore do not require assessment of contributions.

Earlier, during the period of Ch. 24 "ESN" of the Tax Code of the Russian Federation, the Ministry of Finance adhered to a similar point of view. The agency noted that the cost of mandatory medical examinations, reimbursed by the employer to its employees, relates to compensation payments and, accordingly, is not subject to taxation.

In arbitration practice, there are many examples of court decisions rendered in favor of insurers-employers (see, for example, the Ruling of the Supreme Court of the Russian Federation, resolution Arbitration Court Volga region).

"My business" recommends: for a mandatory medical examination, choose the “no problem” path. That is, conclude contracts with medical organizations or insurance companies on your own. Then extra "infusions" into the budget in the form of fines and penalties can definitely be avoided. If you compensate employees for the costs of a mandatory medical examination, most likely you will have to defend your right not to pay insurance premiums and not withhold personal income tax from the amount of compensation in court.