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Why, to whom and how much to pay: what you need to know about health insurance?

Why, to whom and how much to pay: what you need to know about health insurance?

One of the key decisions of the government, which significantly influenced the lives of Kazakhstanis, was the introduction of social health insurance. Previously, medical insurance was voluntary, but now it has become mandatory. The Health Insurance Fund answered the most common questions of citizens. 

Why do you need insurance in the FSMS?

Deductions for compulsory health insurance are as mandatory as the payment of pension and social contributions. By paying a contribution that does not exceed three thousand tenge, for example, for payers of a single cumulative payment, a patient can receive medical services, including expensive ones , the press service of the Medical Insurance Fund said.

For example, the average cost of cardiac surgery on the heart is 3.8 million tenge, neurosurgery – 3.5 million tenge, orthopedic – 1.3 million tenge. And the protocol of in vitro fertilization costs an average of 800 thousand tenge. A patient with the status of “insured” can receive them within the framework of compulsory health insurance for free .

The total amount of financing for high-tech medical services in 2020 almost doubled compared to 2019 and amounted to about 41 billion tenge.

What medical services can be obtained under insurance?

According to the new Health Code, the system of compulsory social health insurance provides:

– specialized medical care on an outpatient basis (including preventive medical examinations; reception and consultations by specialized specialists in the direction of district doctors; dynamic monitoring by specialized specialists of persons with chronic diseases; provision of emergency and planned dental care to certain categories of the population; diagnostic services, in including laboratory ones );

– specialized, including high-tech, medical care in hospital substituting, in hospital conditions in a planned and emergency form;

– medical rehabilitation;

– provision of medicines , medical devices, specialized medical products, immunobiological preparations in the provision of medical care in the compulsory medical insurance system in the provision of the above types of medical care, the fund said.

What to do if the required procedure is not included in the OSMS?

Even if you are not insured , you are entitled to health care in the state-guaranteed free medical care package . Receptions of a local doctor, a pediatrician, a general practitioner, a house call, an ambulance, emergency care at the level of a polyclinic and hospitals, treatment of socially significant, infectious diseases, oncological diseases are included in this package and are provided to everyone regardless of the insurance status.

If it is necessary to receive a service that is not provided for either by the package of guaranteed volume of medical care or compulsory medical insurance, it is provided on a paid basis. In particular, these are dental services (with the exception of certain categories of patients), cosmetology , plastic surgery , and so on.

How to check if you have health insurance?

You can check the status of your insurance in the OSMS system in several ways:

– on the website of the Social Health Insurance Fund https://fms.kz through the “Check Status” pop-up window in the lower right corner, where you must enter the IIN;

– in Telegram SaqtandyryBot , you can select the command “Main menu”, then “Determine the status of insurance”, then enter the IIN.

– in the personal account of the e-government portal https://egov.kz/cms/ru. Upon authorization, the status is displayed automatically among the user details.

How to insure if the user has not found himself in the system?

If a citizen is not insured, it means that he has not contributed for one or several months starting from January 1, 2020. You can check this through the  SaqtandyryBot Telegram bot or by ordering the electronic state service “Issuance of information on participation as a consumer of medical services in the system of compulsory social health insurance” on the Egov.kz portal.

Then you need to pay for the periods in which there is a debt.

It should be noted that from employees , contributions to compulsory health insurance not transferred in a timely manner are collected from penalties for each day of delay. It is equal to 1.25 times the official refinancing rate set by the National Bank.