Mandatory Social Health Insurance (MSHI)
Implementation of Mandatory Social Health Insurance (MSHI) has begun in January 1, 2020. Due to its implementation, healthcare funding has increased by more than 2 times: from KZT 1 trillion in 2019 to KZT 2.2 trillion in 2021. In 2022, it is planned to allocate KZT 2,049 trillion for medical care to the population, including KZT 1.2 trillion for Statutory Free Medical Assistance and KZT 838 billion for MSHI. A significant increase in healthcare funding at the expense of MSHI has allowed to improve the availability of medical care.
Basic principles of the MSHI system:
- social orientation: the state pays contributions for 11 million citizens from 15 benefit-entitled categories of population;
- shared 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 necessary amount of medical care, regardless of the amount of paid contributions;
- money goes to a patient: a patient can select a medical organization to receive medical services if it is a provider of the Fund;
- protection of patient rights: the Fund pays medical organizations for medical services only after verifying the quality and volume of medical care provided.
Statutory Free Medical Assistance
Statutory Free Medical Assistance (SFMA) at the expense of budget funds is provided to:
- citizens of the Republic of Kazakhstan,
- foreigners, permanently residing on the territory of the Republic of Kazakhstan (and having a residence permit),
- stateless individuals permanently residing on the territory of the Republic of Kazakhstan (and having a residence permit).
Foreigners and stateless individuals temporarily staying in the Republic of Kazakhstan and asylum seekers have the right to receive SFMA for diseases that pose a danger to others.
SFMA is provided to citizens regardless of the status of insurance.
The Statutory Free Medical Assistance (SFMA) includes:
- Ambulance services, including the involvement of medical aviation in certain cases.
- Primary healthcare services (PHS), including:
7) sanitary/anti-epidemic and sanitary-preventive measures in the foci of infectious diseases.
- Specialized medical care in outpatient facilities:
4) diagnosis and treatment of chronic diseases subject to dynamic monitoring.
- Specialized medical care in hospital-replacing conditions:
3) treatment of chronic diseases subject to dynamic monitoring.
- Specialized medical care in hospital conditions is provided:
4) as scheduled.
- Medical rehabilitation:
2) for tuberculosis patients.
- Palliative care.
- Provision of blood-derived products upon availability of medical indications when delivering specialized medical care.
- Anatomicopathological diagnostics when providing specialized medical care in outpatient, hospital-replacing and hospital conditions.
- Sending Kazakhstani citizens for treatment abroad and (or) attracting foreign specialists for treatment in domestic medical organizations.
- Provision of medicines, medical products, specialized medical products, immunobiological medicines.
Mandatory Social Health Insurance
Citizens who regularly pay contributions to MSHI and have the "INSURED" status can receive a wider list of medical services without paying for them additionally.
The list of Mandatory Social Health Insurance includes:
- Outpatient medical care (diagnosis and treatment of diseases):
- preventive medical examinations (except for those delivered under SFMA);
- appointments and consultations of medical specialists under referral issued by a primary healthcare doctors;
- case follow-up of individuals having chronic diseases by medical specialists;
- delivery of emergency and elective dental care to certain categories of population;
- diagnostics services, including laboratory diagnostics pursuant to the list;
- other procedures and manipulations pursuant to the list;
- Specialized (high-tech) medical care in hospital-replacing conditions (except for treatment of diseases under SFMA); as well as medical services at home for diseases that cause deterioration of the epidemiological situation in the country and in cases of suspicion of them.
- Specialized (high-tech) medical care in hospital conditions in a scheduled basis (except for treatment of diseases under SFMA).
- Specialized emergency medical care in hospital conditions, including carrying out medical and diagnostic measures in the reception departments of hospitals until a diagnosis is established that does not require treatment in a hospital (except for treatment of diseases under SFMA).
- Medical rehabilitation.
- Anatomicopathological diagnostics.
- Preparation of a deceased donor.
- Provision of medicines and medical products, when delivering the following services under MSHI system:
- specialized (high-tech) medical care in hospital and hospital-replacing conditions pursuant to the medical formularies of healthcare organizations;
- primary healthcare and specialized medical care in outpatient conditions pursuant to the list of medicines and medical devices approved by the authorized body for certain categories of citizens with certain diseases (conditions).
To whom and how much to pay for MSHI?
Since January 1, 2022, in connection with the increase in the minimum wage and monthly calculation index (MCI), the amounts of contributions and deductions for mandatory social health insurance have changed.
- Employer: 3% out of an employee's salary, but not more than KZT 18.000, since the calculation object should not exceed 10 minimum wages. NOTE: if an employee belongs to one of the 15 benefit-entitled categories, then it is not necessary to make deductions for him/her.
- Employees, including those receiving income under civil contracts: 2% out of income, but not more than KZT 12.000, since the calculation object should not exceed 10 minimum wages.
- Individual entrepreneurs and individuals engaged in private practice: 5% of the 1.4-fold size of the minimum wage or KZT 4.200.
- Self-employed citizens make a single bundled payment:
- for residents of villages: 0.5 MCI or KZT 1.531.5.
- Direct payers: 5% out of the minimum wage or KZT 3.000.
- The state pays for 15 benefit-entitled categories of citizens that are more than 11 million people. The amount of contribution per person this year is KZT 3,614.2.
The benefit-entitled categories that are insured at the expense of the state include:
- children under 18;
- unemployed pregnant women;
- unemployed individuals raising a child until the age of three;
- individuals on maternity leave/leave due to adoption of a newborn child, as well as those taking care of a child until the age of three;
- mothers of many children awarded with "Altyn Alka", "Kumis alka" pendants or who previously received the "Mother Heroine" title , as well as awarded with the orders of "Maternal Glory" of the I and II degrees;
- unemployed individuals caring for a disabled child;
- individuals caring for the lifelong disabled;
- disabled people;
- pensioners and WWII veterans;
- individuals studying full-time in organizations of secondary/ technical and vocational/ post-secondary/ higher education as well as postgraduate education;
- individuals registered as unemployed;
- unemployed recipients of state targeted social assistance;
- unemployed oralmans;
- individuals serving sentences under a court verdict in institutions of the penal enforcement system, with the exception of institutions of minimum security;
- individuals held in pre-trial detention facilities.
If you belong to one of the above categories and you are not insured, then you need to collect the supporting documents according to the list and submit them to CSC. Information will be sent to government agencies for confirmation. After all the necessary procedures, the state will pay contributions for you, and you will be granted the "INSURED" status being a representative of benefit-entitled category.
How do I check my status in the MSHI system?
There are several options to check your status in the mandatory health insurance system.
- e-Government Portal (Egov.kz).
To do this, in "Healthcare" section, you need to find the service called "Issuing information about participation in the mandatory social health insurance system as a consumer of medical services and about the amounts of deductions and (or) contributions", click "Order Service" button, fill-in your IIN. The result will appear within 10 minutes.
- Official website of the Social Health Insurance Fund is fms.kz.
The pop-up window "Verify status" is located in the right corner of the website page. Just click it and specify your IIN.
- Qoldau 24/7 mobile app.
Select "Check the insurance status" section in the menu, then enter your IIN. The status and information on availability of payments for the previous 12 months will appear in the window. You can download the app in PlayMarket and AppStore.
- @SaqtandyrýBot in Telegram.
To run the bot, you need to follow the link: https://t.me/SaqtandyryBot or enter its name in the search bar, then select "Check the insurance status" section, enter your IIN.
You can find out about the deductions and contributions made to your name by ordering the public service called "Issuing information about participation in the mandatory social health insurance system as a consumer of medical services and about the amounts of deductions and (or) contributions" by following the link: https://egov.kz/cms/kk/services/health_care/pass171-2_mz
Protection of patient rights
If you are not satisfied with the quality of medical services provided, faced the refusal to provide medical care or rude attitude from medical staff, facts of extortion of funds for medical services that are provided within the statutory free medical assistance and in the system of compulsory social health insurance, or other issues, you should defend your patient rights. There are several options here.
- Contact the Patient Support and Internal Audit Service for help. Such a service works in every medical organization. Make a written statement indicating the contact details for feedback. More detailed information can be found at the reception of an outpatient clinic or hospital.
- Contact the Call Center of the Regional Health Department.Since all the medical organizations are subordinate to health departments, their representatives will be able to help you settle your issue.
- Submit a request via the Qoldau 24/7 mobile app.After submission of a request via Qoldau 24/7, specialists of the Social Medical Insurance Fund will contact a medical organization and check the quality of the service and if you did not receive the service for some reason, they will find out the reason for refusal. All the requests are entered into the register with assignment of a registration number, using which you can track a request status.
- Submit a request via @SaqtandyrýBot in Telegram. To do this, select "Send message to 1406" command in the main menu. A request should contain the matter of the issue, as well as the name of the region and medical organization.
- Contact 24/7 Single Call Center of the Fund by calling 1406. Call from mobile and landline phones throughout Kazakhstan is free-of-charge.
- Submit a request on the official website of the Social Health Insurance Fund (fms.kz). To do this, select "Submit a request" command, then "Ask a question/make a complaint" window opens, where you need to fill in all the fields.
Last update: 30.03.2022