Social Security Scheme on Health Care for Person Defined by the Provisions of the Labour Law. Date June, 16, 2016 Heng Sophannarith
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1 Social Security Scheme on Health Care for Person Defined by the Provisions of the Labour Law Date June, 16, 2016 Heng Sophannarith
2 ម ត ក I. Purpose II. Scope of Implementation III. Contribution IV. Benefits V. Exclude Services VI. Chronic diseases VII. Condition to get medical services VIII. Provider Payment Mechanism
3 I. Purpose Provided preventive services, medical care and provide daily allowance for absence of treatment and maternity leave.
4 II. Scope of Implementation The initial phase shall only be implemented to the NSSF members suffering from permanent disability and survivors (spouse and children under the dependent of victim, as a NSSF member, passes away resulting from occupational risk). In respect of the implementation for the dependent of the NSSF members, including spouse and children, shall be determined subsequently. This implementation shall be launched primarily to the enterprises/ establishments under the scope of Phnom Penh capital, Kandal province, Kompong Sper province and reach subsequently other provinces in conformity with the technical situations and actual locations. The Social Security Schemes on Health Care for Persons Defined by the Provisions of the Labour Law shall be launched from 01 May 2016 onwards.
5 III. Contribution Employer and worker under the Provisions of the Law on Social Security Schemes for Persons Defined by the Provisions of the Labour Law shall be compulsory to pay contribution of Health Care to NSSF. Contribution rate of Health Care borne by employer shall be set equally to 1.3 (one three) % of average wage in the classification of workers monthly wage. Contribution rate of Health Care borne by worker shall be set equally to 1.3 (one three) % of average wage in the classification of workers monthly wage. Contribution rate of Health Care borne by survivors or person receiving pension shall be set equally to 1.3 (one three) % of the benefits of person concerned.
6 IV. Benefits Health Care Benefits comprise the health benefit packages and the defined health prevention services. 3.1 Health Benefit Package Health benefit packages comprise the medical care, patient referral service, corpse transportation, and daily allowance. A. Medical Care A.1 Inpatient Treatment and care services with medical professional technics Diagnosis, laboratory, and other medical screening services Surgical apparatus and other medical equipment in the need of treatment Prescribed medicine Room (normal) and food provided by health facilities.
7 IV. Benefits (con t) A.2 Outpatient Treatment and care services with medical professional technics Diagnosis, laboratory, medical imagery and other medical screening services Surgical apparatus and other medical equipment in the need of treatment Prescribed medicine A.3 Emergency Service Emergency service is any interventions that are performed unintentionally; and these interventions can be performed promptly in order to resuscitate or prevent from losing any parts of patient s body. A.4 Physiotherapy and Kinesitherapy Services A.5 Delivery and Prenatal and Postnatal Services A.6 Rehabilitation Service
8 IV. Benefits (con t) B. Patient Referral Services and Corpse Transportation C. Daily allowance shall be granted in the duration of sickness or other accidents including point 1 of Article 4 in this Prakas. 3.2 Health Prevention Service Health prevention service shall be provided by the National Social Security Fund, national programs, institutions, and relevant organizations involved with health.
9 V. The excluded services in the medical care are 1. Free medical treatment shall determine in public health facility policy 2. Dental care (except extraction and pain kill 3. Sex interchange and transsexual surgery 4. Organs transplantation (bone marrow, kidney, liver, health and pancreas) 5. Artificial Insemination in case of infertility 6. Self treatment 7. Cosmetic surgery and medical implants 8. Contact lens and eye- laser treatment
10 V. The excluded services in the medical care are 9. Treatment of alcoholism or drug abuse 10. Infertility treatment 11. Artificial globe ocular operation 12. Cardio vascular surgery 13. Hemodialysis 14. Chemo therapy for cancer treatment In case of the emergency, all services mentioned above shall be granted.
11 VI. Chronic Disease Chronic disease have been determine 14 cases Chronic disease services shall be provided by public health facilities and with essential drug only. For the drugs are not in the essential drug list shall be borne by the patient.
12 VII. To get medical care services shall fulfill the following condition: 1 Medical Care Working in the enterprises/establishments registered in the National Social Security Fund for Health Care Scheme. Registered in the NSSF Paid contribution for Health Care Scheme in a qualifying period of two consecutive months or at least 6 (six) months within a period of the last 12 (twelve) months until encountering the health problems or maternity. In case the NSSF member has already paid contribution in a qualifying period of 2 (two) consecutive months; unfortunately, they become unable to pay contribution due to the termination of employment contract, the NSSF member has an entitlement to the medical care services in a qualifying period of 2 (two) consecutive months from the date of employment contract termination of person concerned.
13 1. To get daily allowance shall fulfill the following condition: 2 The workers who are abstention from work because of sickness, accident, and maternity leave. Daily allowance Fulfilled the conditions as set forth in point 6.1 in this Prakas. Ask for leave permission from employer in a period of sickness treatment Paid contribution at least in a qualifying period of 9 (nine) consecutive months for maternity leave.
14 2.To get eligible shall fulfilled the condition as following: Having completed condition 1&2 Free treatment in the health facilities recognized by NSSF not exceed 180 (one hundred and eighty) days within 12 (twelve) months including inpatient and outpatient except that the treatment services as stipulated in Article 4 in this Prakas. 70% of daily allowance of workers daily average wage for a period of abstention from work due to treatment with prescription for over 7 (seven) consecutive days. Wage from employer in case of the abstention from work because of treatment with prescription for 7 (seven) consecutive days downward. 70% of daily allowance of workers daily average wage in a qualifying period of 90 (ninety) days for prenatal and postnatal leave.
15 2.To get eligible shall fulfilled the condition as following (Con t) Referral service shall be provided incase emergency cases. Referral Services and Corpse Transportation Corpse Transportation shall be provided based on the price of health facilities recognized by NSSF.
16 4.Procedures to get medical treatment The NSSF member has to show the identity recognized by NSSF (fingerprint, Electronic National Identification Card, or NSSF membership card). Procedures to get medical treatment In case of the emergency, the patient can access the service at the nearest health facilities. NSSF will reimburse the patient or health facilities curing the NSSF member based on the level of health facility service, quality, and case-based payment as set forth in Annex 1 and 2 of Prakas on Provider Payment Method. If those health facilities haven t signed an agreement with NSSF, the patient or representative shall inform promptly NSSF.
17 Thanks you for your attention
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