The Law on Health Insurance and other legal acts of our country establish a compulsory health insurance model based on the principles of universality (obligation) and solidarity. It provides the possibility to insured persons to receive individual health care services financed from the Compulsory health insurance funds (CHIF) budget.
Healthcare, covered by CHIF:
individual health care services provided on the primary, secondary and tertiary levels of health activities;
compensation of costs of the replacement of limbs, joints and organs with prostheses and costs related to the acquisition of prostheses;
reimbursement of expenses for the insured, related to medicines and medical aid equipment, as defined by the Law on Health Insurance;
state assistance in acquisition of orthopaedic devices in accordance with the procedure laid down by the Ministry of Health;
preventive medical assistance (provision of information on the issues of disease prophylaxis, prophylactic health check-ups of the insured, as prescribed by the Ministry of Health, cervical, breast, colorectal, prostate cancer screening programmes, etc.);
nursing care and social services, supportive treatment services at nursing and supportive treatment hospitals in accordance with the procedure and within the time limits set out by the Ministry of Health, but not longer than 120 days per calendar year.
The costs of individual health care services are covered from the budget of the CHIF according to the lists, approved by the Ministry of Health.
The basic conditions for payment of health care services from the CHIF are:
- Emergency medical services are provided free of charge to all residents. The extent of emergency medical services are approved by the Minister of Health in 2004.
- Secondary and tertiary health care services are provided to the insured by compulsory health insurance.
- In order to get healthcare services patient should always turn to his family practitioner first of all. If family practitioner decides that it is necessary, then he will give a referral to a specialist and that consultation will be covered by CHIF.
- The admission to the hospital takes place with the referral issued by a family practitioner or specialist. Only in the case of an emergency patient can go directly to the hospital.
- The patient has the right to choose a primary health care facility and doctor, as well as secondary or tertiary care facility and physician.
- If patients, entitled to free health care services, on their own initiative choose the more expensive services, materials or procedures for these services, they cover difference of the actual price and free services, materials or procedures base price themselves.
The costs of healthcare services
Reimbursable pharmaceuticals and medical aids