Health Insurance Scheme - the law on Health Insurance in Cambodia

Health Insurance Scheme presentation in ppt file.

1. Social Security Laws Presenter Seng Somalita

2. 1. Introduction The launch of the social security scheme Phase II on Health Care was issued in the Rectangular Strategy Phase III of the Royal Government. Established by Sub-Decree No. 01 SD.E, dated 06 January 2016. The scheme covers health care for persons defined by the Labor Law. It aims to protect workers from both occupational and non-work-related health issues. Contributes to health promotion and prevention for workers. Health Insurance Scheme 2

3. 2. Health Care Scheme Health care s cheme refers to social health insurance which includes: Benefit provision, Health prevention, Medical care services, Daily allowance for work ceasing due to sickness or non-work accidents, and maternity leave. Health Insurance Scheme 3

4. 3. Contribution Payment and Contribution Rate Compulsory contributions by employers and workers until 31 December 2017. From 01 January 2018, contributions are allowed by employers. Health Insurance Scheme 4

5. 4. Health Care Benefits Health care benefits refer to health care package and health prevention services. . Health care package refers to medical care services, patient or victim referral service and copse transportation, and daily allowance . Health care package includes : Medical care services Patient or victim referral service Corpse transportation Daily allowance Health Insurance Scheme 5

6. 4.1.Medical Care Services In-patient services: Treatment and care services Diagnosis, laboratory, and medical screening Surgical apparatus and equipment Prescribed medicine Patient room Outpatient services: Similar services as in-patient Emergency services: Interventions for resuscitation or prevention of limb/organ loss Nearest health facility access Reimbursement if informed within 48 hours via Hotline: 1286 Kinesitherapy and physiotherapy Delivery and prenatal/postnatal care Rehabilitation services Health Insurance Scheme 6

7. 4.1.Medical Care Services (cont.) Rehabilitation services refer to medical care services with the aim of helping the patients to restore and rehabilitate their ability, skill, and function for their daily living as well as the communication skill lost or damaged due to sickness, injury, or disability. Health Insurance Scheme 7

8. 4.2. Patient Referral and Corpse Transportation Patient referral service: Emergency cases with health facility ambulance. Corpse transportation: Based on health facility prices recognized by NSSF. Health Insurance Scheme 8

9. 4.3.Daily Allowance Granted during work abstention due to sickness, accident, or maternity leave. Free medical care as per public health policy. 70% of daily allowance based on average wage provided to patient/victim. Health Insurance Scheme 9

10. 5. Health Prevention Includes timely diagnosis, health risk identification, consultation, and necessary interventions. Comprises screening, health education, and vaccination programs. Provided by NSSF, national programs, institutions, and relevant health organizations. Health Insurance Scheme 10

11. II. Pensions Benefits: Old age pension and allowance Invalidity pension Survivors ’ pensions and allowance Eligibility NSSF member aged 55+ with at least 20 years of registration and 60 qualifying months of contribution. Early pension for premature mental/physical worn state before age 55. Lump sum allowance for members with less than 60 qualifying months . Health Insurance Scheme 11

12. Occupational Risk Employment injury: Accidents during work or commute. Occupational disease: Identified by joint Prakas of Ministers in charge. Benefits Medical care services Daily allowance for temporary disability Disabled pension/allowance for permanent disability Funeral benefits and survivors’ pension Health Insurance Scheme 12

13. Formulation of National Social Security Fund (NSSF) Established by Sub-Decree #16 (RGC) of March 2, 2007. Duties include managing social security regime, guaranteeing benefits, and collecting contributions. Initial resources from the State, contributions from members and employers. Registration initially in Phnom Penh, Kampong Speu , and Kandal . Monthly contribution rates based on average monthly wage. Health Insurance Scheme 13

14. NSSF Operational Details Applies to enterprises with 8+ employees. Implementation of occupational risks insurance schemes. Specific hospitals for work-related injury treatment: Phnom Penh: Calmette Hospital, Russian Hospital, Lok Sang Hospital Kandal and Kampong Speu : Chey Chomnas Hospital, Kampong Speu Referral Hospital Contribution rates: 0.8% of employee’s average monthly wage. Health Insurance Scheme 14

15. Conclusion The Health Insurance Scheme under the NSSF provides comprehensive health care and benefits for workers. Ensures protection from both occupational and non-work-related health issues. Aims to promote and prevent health issues among workers. Health Insurance Scheme 15