Services included in Compulsory Medical Insurance Package in Azerbaijan disclosed

Services included in Compulsory Medical Insurance Package in Azerbaijan disclosed

BAKU, Azerbaijan, Jan. 14

Trend:

Services included in the Compulsory Medical Insurance Package, which has been approved by the decision of Azerbaijan’s Cabinet of Ministers, has been disclosed, Trend reports with reference to the Cabinet.

A package is a set of medical services that as part of compulsory medical insurance are insured in the appropriate form, volume and under certain conditions are rendered to the insured persons. It includes emergency medical care, primary healthcare services, specialized outpatient care, inpatient medical care, in total - 2,550 types of medical services.

Six of these services are emergency medical care services, 35 primary healthcare services, 1,265 specialized outpatient care services and 1,244 inpatient care services. Medical and surgical treatment of diseases widespread in Azerbaijan with a risk of disability and death are also covered by the compulsory medical insurance. These services include more than 150 vital operations with high cost.

In accordance with the law “On Medical Insurance”, medical services under the Services Package will be provided to citizens only if there is medical evidence (excluding emergency medical care) in medical institutions with which the State Agency for Compulsory Medical Insurance has relevant contracts.

The package of services includes the names of medical services, tariffs, insurance limit, cases requiring co-financing, conditions for the provision of medical services, depending on their type, as well as waiting time.

A certain part of the cost of medical services that must be paid by the insured is called the amount of co-financing and it will be applied to the insured persons if they don’t comply with the conditions specified in the Services Package. The terms of payment of this amount are determined by the Services Package, and it must be paid directly to the medical institution.

The amount of co-financing applicable to services provided on an outpatient basis is paid in the following manner:

If a citizen comes to a medical institution at the place of registration to get medical services on an outpatient basis within the administrative territory without a family doctor’s referral, then a citizen must pay the amount of co-financing worth five manat ($2) for each insured event.

That is, if you have been registered in Azerbaijan’s Sheki city and without seeing a family doctor, you directly see a doctor in a medical institution in Sheki city, then you must pay the amount of co-financing worth five manat ($2) due to the non-compliance with the conditions prescribed in the Service Package.

If a citizen comes to a medical institution located in another administrative territory within the medical territorial zone to get medical services on an outpatient basis without a family doctor’s referral, then a citizen must pay the amount of co-financing worth five manat ($2) for each insured event.

That is, if you have been registered in Sheki city and without seeing a family doctor, you directly see a doctor in the Gakh medical institution (located in another administrative territory, but within the medical territorial zone), you must pay the amount of co-financing worth five manat ($2).

If a citizen, without a family doctor’s referral, comes to a medical institution located outside the medical territorial zone where he has been registered to get medical services on an outpatient basis, then a citizen must pay the amount of co-financing worth 15 manat ($8) for each insured event.

For example, if you have been registered in Sheki city and without seeing a family doctor, you directly see a doctor in a medical institution of Shamakhi city (located in another medical territorial zone), you must pay the amount of co-financing worth 15 manat ($8).

The procedure for paying the amount of co-financing for getting medical services in a hospital is as follows:

If a citizen, without a referral from a medical institution situated in the place of registration or residence, comes to a medical institution located in another administrative territory but within a medical territorial zone, then a citizen must pay the amount of co-financing worth 30 manat ($17) for each insurance case exceeding 100 manat ($58).

For example, if you are registered in the Guba district and without contacting a family doctor at the place of registration, you apply for medical services in a hospital in Khachmaz district (in the medical territorial department, but in a different administrative territory), then due to non-compliance with the conditions established in the Service Package, you must pay co-financing in the amount of 30 manat ($17.6).

Outside the medical territorial department: if a citizen without referral from a medical institution located in the administrative territory at the place of registration applies for a medical service in a medical institution located outside the medical territorial department where he is registered, then for each insurance case the cost of which exceeds 100 manat ($58.8), the citizen must pay co-financing in the amount of 90 manat ($52.9).

For example, if a citizen is registered in the Guba district and without contacting a family doctor at the place of registration, applies for medical services in a hospital in the Shamakhi district (located in another medical territorial department), then due to non-compliance with the conditions established in the Service Package, he must pay the co-financing in the amount of 90 manat ($52.9).

At the same time, for each magnetic resonance imaging and computed tomography service provided on the outpatient basis, a citizen must pay the co-financing in the amount of 20 manat ($11.7). All medical services to the insured are provided according to the relevant referral. All laboratory and diagnostic services, without undergoing appropriate examination of a doctor, are carried out at the expense of the citizen.

If the conditions specified in the Service Package are met (referring to a family doctor, referring to a specialized doctor based on the direction of the family doctor, etc.) while providing emergency and urgent medical care, outpatient (excluding CT and MRI) and inpatient care, payment of co-financing is not required.

The application of the co-financing will begin on April 1, 2020.

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