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What should you know about the compulsory social medical insurance system?

Every once in a while everyone, even those who consider themselves absolutely healthy, needs some medical treatment. Therefore the state gradually implements the compulsory social medical insurance system (CSMI). In this article we will tell you how it works, how you can become a part of it, what services it offers and describe the stages of its implementation.

1

How does the CSMI system work?

Within the CSMI system framework, medical assistance will be provided at the expense of the assets of the Social Health Insurance Fund (hereinafter - the Fund).

The state will make contributions to the Fund for socially vulnerable categories of the population, employers - for hired workers, workers and self-employed citizens - for themselves.

Thus, contributions are made by everyone within areas of their responsibility: the state - for the development of the health system and support for socially vulnerable groups of the population, employers - for working conditions of their employees, citizens - for their own health and disease prevention. Therein lies the principle of the joint responsibility of the OSMS system between the state, the employer and citizens.

2

Who takes part in the CSMI system?

All citizens of Kazakhstan, as well as repatriates, foreign citizens and members of their families permanently residing in Kazakhstan become participants of the compulsory social insurance system. Each participant of the system can get access to the necessary help and medicinal assistance, irrespective of the amount of his contribution - the package of compulsory medical insurance is equal for everyone.

3

Who makes payments to the fund and in what amount?

Employers and individual entrepreneurs start to make deposits to the Fund from the 1st of July, 2017, the State and economically inactive population - from the 1st of January, 2018, salaried employees - from the 1st of January, 2019.

The employers pay for their employees:

  1. since 1st of July, 2017 – 1% from the income of each employee;
  2. from 1st of January, 2018 – 1.5% from the income of eachemployee;
  3. from 1st of January, 2020 – 2% from the income of each employee;
  4. from 1st of January, 2022 – 3% from the income of each employee.

For example, if the average monthly salary in 2018 comprises 152 106 tenge, then from 1st of January, 2018 the employer will transfer 1.5% of the sum to the Fund - about 2 282 tenge monthly at his own cost and expense.

Together with that the employer is free from payments for the employees from the vulnerable groups of the population, military servants, officers of the special state agencies and law enforcement bodies.

The individual entrepreneurs pay 5% from 2 minimum wages (MW) for themselves and for their employees from the 1st of July, 2017.

In 2017 the amount of the MW comprises 24 459 tenge, consequently the deposit of the IE from the 1st of July, 2017 comprises 2 445.9 tenge.

The payroll employees pay:

  1. from 1st of January, 2019 – 1% of their income;
  2. from 1st of January, 2020 – 2% of their income.

For example, if the income of a payroll employee comprises 100 000 tenge, then from the 1st of January, 2019 the contribution to the Fund that each employee will have to pay will be 1000 tenge. Payments for the employees are made by the employers on a monthly basis.

From the 1st of January, 2018 the economically inactive population will pay 5% from the minimum wages (MW). The citizens who have gone abroad pay at the same rate.

According to forecasts, in 2018 the MW will comprise 28 284 tenge, thus the payments of this group of the population will comprise 1414 tenge monthly.

The payments can be made via banks or JSC “KazPost”.

The State pays:

  1. from 1st of January, 2018 – 3.75% from the State deposit estimation subject;
  2. from 1st of January, 2019 – 4% from the State deposit estimation subject;
  3. from 1st of January, 2022 – from 4% to 5% from the State deposit estimation subject.

The object of calculating the state's contributions is the average monthly wage that precedes the 2 years of the current financial year. For example, the average monthly wage for 2016 is 134,108 tenge. Hence, from 2018 the state will pay 3.75% of this amount, which is 5 029 tenge per month or 60 349 tenge per year.

4

Do I fall under a category of persons the state pays for?

Yes, if you fall under one of the following 14 categories:

  1. children;
  2. persons registered as unemployed;
  3. unemployed pregnant women;
  4. unemployed persons upbringing a child (children) until his (their) third birthday;
  5. persons in paternity leaves, adoptive parent’s leave for the birth of a child (children), the adoption of a newborn child (children), the care of a child (children) until they reach the age of three;
  6. unemployed persons caring for a disabled child;
  7. recipients of the pension benefits, including the participants and disabled veterans of the World War II;
  8. persons already imprisoned under sentence in the facilities of the penal (penitentiary) system (except for the facilities of the minimum security);
  9. persons kept in the pretrial detention facilities;
  10. unemployed repatriates;
  11. mothers of large families awarded with pendants “Altyn Alka”, “Kumis Alka”, or with the Soviet order “Mother-heroine” or First/Second Class “Mother’s Glory” order;
  12. disabled persons;
  13. persons on the intramural form of study in the institutions of the secondary, technical and professional, post-secondary, higher education, and post-graduate education;
  14. persons graduated from the intramural course of the institutions of the secondary, technical and professional, post-secondary, higher education, and post-graduate education within three calendar months after the month of graduation.
5

What services can i get within the framework of the CSMI system?

The CSMI service package includes ambulatory medical care, first aid, consultations, inpatient treatment, hospitalization, surgery, laboratory services, medicine prescription. Detailed lists of services and medicines for the OSMS package will be determined later by appropriate government regulations.

The state established a transitional period until the 1st of January, 2020 during of which you can get outpatient and inpatient emergency care in case of absence of insurance when applying to the policlinic. However the free routine inpatient care will be unavailable for you – it will only be provided to the participants of the CSMI system.

Medical treatment and pharmaceutical aid within the framework of the social medical insurance package for the patients-participants of the CSMI system are free - the healthcare organization receives the payment for provided services directly from the Fund.
In case of dissatisfaction with the quality of medical services rendered, one can report this directly to the Fund.

It is important to know that you can get healthcare services on your CSMI within three months since the last contribution to the Fund. Once this period expires, you will have to make payments for the missed period (not more than 12 months) to be able return to the system.

6

What should be done to receive medical aid on the CSMI system?

First of all you should register in the most convenient policlinic according to the place of residence.

You can do it:

  1. in the policlinic by writing an application in any form and submitting the identification document;
  2. via egov.kz web portal:
  • log in or sign up on www.egov.kz;
  • select “Healthcare”;
  • in the “Medical aid” tab click “Attachment to the medical organization of the primary health care”;
  • then click “Order the service online”, fill in the margins of the e-form and send a request.

Electronic digital signature is not required.

The service delivery period: 1 working day.

The end result of the service: response to the request and information on your registration in your personal account on egov.kz.

During the procedure of registration it is important to clarify the group of the population you belong to within the framework of the CSMI: welfare beneficiaries, employee, individual entrepreneur, or unemployed person. It influences upon the order and amount of the insurance benefit. You can check your status (insured or not) on the web portal of the e-government by entering your IIN or in your policlinic.

After registering in the policlinic and assuring that you became a participant of the CSMI system, you can see a primary care physician (a therapist) who will prescribe treatment and all necessary medications.

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