The compulsory social health insurance system
The compulsory social health insurance system has been in effect since January 1, 2020. Thanks to its implementation, funding for the healthcare sector has more than doubled. In 2019, before the launch of compulsory medical insurance, about 1 trillion KZ was allocated for a guaranteed volume of free medical care. In 2023, more than 2.5 trillion KZ is allocated to finance medical care to the population, including 1.4 trillion for the State Fund for Medical Care, and more than 1 trillion KZ for the Compulsory Medical Insurance. A significant increase in healthcare financing through compulsory medical insurance has improved the accessibility of medical care.
Basic principles of the compulsory social health insurance system:
social orientation - the state pays contributions for 11 million citizens from 15 preferential categories;
joint responsibility – the state, employers and citizens are responsible for the health of the population;
equal access to medical care – every insured person has the right to the required amount of medical care, regardless of the amount of paid contributions;
the money goes to the patient - the patient can choose a medical organization according to his preference to receive medical services if it is a provider of the Fund;
protection of patient rights – the Fund makes payments to medical organizations for medical services only after monitoring the quality and volume of medical care provided.
State guaranteed volume of medical care
A guaranteed volume of free medical care at the expense of budgetary funds is provided:
citizens of the Republic of Kazakhstan,
kandas,
refugees,
foreigners permanently residing on the territory of the Republic of Kazakhstan (and having a residence permit),
stateless persons permanently residing on the territory of the Republic of Kazakhstan (and having a residence permit).
Foreigners and stateless persons temporarily staying in the Republic of Kazakhstan, people seekers have the right to receive guaranteed volume of medical care for diseases that pose a danger to others.
The guaranteed volume of medical care is provided to citizens regardless of their insurance status.
The guaranteed volume of free medical care (GFMC) includes:
Ambulance services, including the use of medical aviation in certain cases.
Primary health care (PHC) services, including:
1) diagnosis, treatment and management of the most common diseases;
2) preventive examinations of target population groups (children, adults);
3) immunization (vaccination);
4) formation and promotion of a healthy lifestyle;
5) measures to protect reproductive health;
6) monitoring pregnant women and postpartum women in the postpartum period;
7) sanitary-anti-epidemic and sanitary-preventive measures in hotbeds of infectious diseases.
Specialized medical care on an outpatient basis:
1) prevention and diagnosis of HIV infection and tuberculosis;
2) services for injuries, poisonings or other emergency conditions, including services of a mobile team for diseases that cause a worsening of the epidemiological situation in the country and in cases of suspicion of them for all persons, regardless of insurance status;
3) diagnosis and treatment for socially significant diseases;
4) diagnosis and treatment of chronic diseases subject to dynamic monitoring.
Specialized medical care in inpatient settings:
1) treatment for socially significant diseases;
2) hospital services at home for diseases that cause a worsening of the epidemiological situation in the country and in cases of suspicion of them for everyone, regardless of insurance status;
3) treatment for chronic diseases subject to dynamic monitoring.
Specialized medical care in inpatient settings provided by:
1) when isolating persons who were in contact with a patient with an infectious or parasitic disease that poses a danger to others, as well as bacteria carriers, virus carriers and persons suspected of having an infectious or parasitic disease that poses a danger;
2) in the treatment of infectious, parasitic diseases and diseases that pose a danger to others;
3) emergency assistance to people, regardless of insurance status, including the conduct of therapeutic and diagnostic measures in the emergency department of a 24-hour hospital;
4) as planned.
Medical rehabilitation:
1) in the treatment of the underlying disease;
2) for patients with tuberculosis.
Palliative care.
Providing blood products and its components if there are medical indications when providing specialized medical care.
Pathoanatomical diagnostics in the provision of specialized medical care in outpatient, inpatient and inpatient settings.
Sending Kazakhstanis for treatment abroad and (or) attracting foreign specialists to carry out treatment in domestic medical organizations.
Providing medicines, medical devices, specialized medicinal products, immunobiological drugs.
Who should pay for compulsory medical insurance and how much?
From January 1, 2023, due to an increase in the minimum wage (MW) and the monthly calculation index (MCI), the amounts of contributions and deductions for compulsory social health insurance have changed.
Employer – 3% of the employee’s salary, but not more than 21 thousand tenge, since the object of calculation should not exceed 10 minimum wages. IMPORTANT: if an employee belongs to one of the 15 preferential categories, then there is no need to make deductions for him.
Employees, including those receiving income under GPC contracts - 2% of their income, but not more than 14 thousand tenge, since the object of calculation should not exceed 10 minimum wages.
Individual entrepreneurs and persons engaged in private practice - 5% of 1.4 times the minimum wage, or 4,900 tenge.
Self-employed citizens pay the ESP:
- for residents of the capital, cities of republican and regional significance – 1 MCI, or 3,450 tenge;
- for residents of other settlements – 0.5 MCI, or 1,725 tenge.
Independent payers – 5% of the minimum wage, or 3,500 tenge.
The state pays for 15 preferential categories of citizens – that’s over 11 million people. The contribution for one person this year is 4,505.6 tenge.
The preferential categories that are insured at the expense of the state include:
children under 18 years of age;
unemployed pregnant women;
unemployed persons raising a child until he reaches three years of age;
persons on leave in connection with pregnancy and childbirth, adoption of a newborn child, as well as to care for a child until he reaches three years of age;
mothers of many children who were awarded the “Altyn Alka”, “Kumis Alka” pendants or who previously received the title “Mother Heroine”, as well as those awarded the Order of “Maternal Glory” of the 1st and 2nd degrees;
unemployed persons caring for a disabled child;
persons caring for disabled people since childhood;
disabled people;
pensioners and WWII veterans;
persons studying full-time in organizations of secondary, technical and vocational, post-secondary, higher education, as well as postgraduate education;
persons registered as unemployed;
unemployed recipients of state targeted social assistance;
non-working oralmans;
persons serving sentences under a court sentence in institutions of the penal system, with the exception of minimum security institutions;
persons held in pre-trial detention centers.
If you belong to one of these categories, but are not insured, then you need to collect a list of supporting documents and submit them to the Public Service Center. The information will be sent to government agencies for confirmation. After all the necessary procedures, the state will pay contributions for you, and the status “INSURED” will be granted as a representative of a preferential category.
How to check your status in the compulsory health insurance system?
There are several ways to check your status in the compulsory health insurance system.
Electronic government portal Egov.kz.
To do this, in the “Healthcare” section, you need to find the service “Issuance of information on participation as a consumer of medical services and on the listed amounts of deductions and (or) contributions in the compulsory social health insurance system,” click on the “Order a service” button, indicate the IIN. The result will appear within 10 minutes.
Official website of the Social Health Insurance Fund fms.kz.
The “Determine Status” pop-up window is located in the right corner of the site page. Just click on it and indicate your IIN.
Qoldau mobile application 24/7.
To do this, you need to select the “Check insurance status” section in the menu, then enter your IIN. The window will display the status and information about the availability of payments for the previous 12 months. You can download the application from PlayMarket and AppStore.
Bot @SaqtandyrýBot on Telegram.
To launch the bot, you need to open the link: https://t.me/SaqtandyryBot or enter its name in the search bar, then select the “Determine insurance status” section, enter your IIN.
You can find out about the deductions and contributions transferred in your name by ordering the state service “Providing information on participation as a consumer of medical services and on the transferred amounts of deductions and (or) contributions in the compulsory social health insurance system” at the link: https://egov. kz/cms/ru/services/health_care/pass171-2_mz
