ArmInfo. Universal health insurance (UMI) in Armenia will provide equal coverage for all insured persons, regardless of solvency and social status (differences may only be due to age and gender characteristics of service). At the same time, along with UHI, voluntary health insurance will be in effect, including services not included in the basic and minimum packages.
Monthly payments in favor of the insured person will amount to 10,000 to 13,700 drams. This is stated in the draft law and a Number of Related Laws>, posted on the Unified Portal of Legal Acts.
On February 2, 2023, the Armenian Cabinet approved the Concept for the introduction of UHI proposed by the Ministry of Health, according to which the introduction of the system was planned for the next 4 years. The year 2023 was considered as a year, and 2024-2026 were called the with the full implementation of the IUD in 2027. According to the plan, the implementation phase of the system should begin in July 2024. And despite the fact that in early July 2024 the World Bank announced its readiness to provide the RA with a $110 million loan to support the program, the implementation of the IUD was postponed to January 2025. On November 1 last year, the Minister of Finance of Armenia Vahe Hovhannisyan made it clear in the parliament that the introduction of the IUD was once again postponed, but this time for an indefinite period, stating that the draft budget for next year does not include a corresponding expenditure item. , - the chief financier of the RA said.
Now, the draft law developed by the Ministry of Health states that the IUD is planned to be implemented in stages, with 2024-2025 designated as a "preparatory stage", and from the moment the law is adopted and the following year when it comes into force, the IUD system will be implemented in full.
Conditions for providing an insurance policy, insured event
A mandatory condition for using the insurance package of the insured person is the mandatory preventive medical examination or being on the waiting list for examination in the manner established by the authorized body.
Cases in which it is not required to undergo a mandatory preventive medical examination are the provision of urgent and emergency medical care and services within the framework of the VMS.
An insured event will also be recognized as an appeal to a medical organization or pharmacy that has concluded a corresponding agreement with the Fund, information about which will be posted on the official website of the Fund.
Status, functions of the Fund
The project envisages the establishment of the Comprehensive Health Insurance Fund, which will be a non- profit organization established by the state. The founder of the fund will be the Republic of Armenia represented by the government. The fund will have the following bodies: a board of trustees, an executive director general, an executive committee overseeing the process of comprehensive health insurance, as well as a risk management and strategic planning committee.
The board of trustees, which is the highest governing body of the fund, will be formed for a period of five years and will consist of nine members. It will include representatives of the authorized body (Ministry of Social Labor, Ministry of Finance, State Control Service, Central Bank), as well as a representative of public associations involved in the protection of the rights of medical workers, patients, employees, employers.
The Fund's current activities will be managed by the Executive Director General, who will be responsible for all issues related to the management of the Fund's current activities.
In turn, the executive committee for supervision of the comprehensive medical insurance process will be a collegial body that, within its competence, will verify the execution of contracts concluded between medical organizations, pharmacies and medical institutions. The committee will also resolve disputes between insured persons and the Fund, carry out financial and economic analysis of the industry and perform other functions stipulated by the fund's charter.
The Strategic Planning and Risk Management Committee will also be a collegial body that will oversee actuarial calculations for assessing the insurance policy, work on determining the amount of compensation for the insurance package by the Fund, analyze possible risks in the field of comprehensive medical insurance and submit recommendations to the Board of Trustees on mitigating their impact, and perform other functions.
Navy budget, reserve fund, audit
The Fund's budget is formed from insurance premiums paid by payers of insurance premiums, additional deductions from the state budget, funds collected from individuals and legal entities in accordance with the law for harm caused to the health of the insured person, when the costs of medical care of the insured person are made at the expense of the Fund's budget, not prohibited by law in other ways.
In addition, in order to stabilize the Fund's budget, cover long-term insurance risks, long-term equalization of CASCO costs, and also to pay bonuses to insured persons, a reserve fund of the Fund will be created, which is formed from annual deductions in the amount of ten percent from the Fund's budget.
It is planned that the annual audit of the Fund's financial statements will be carried out by an external independent internationally recognized organization, which is part of the 10 largest audit networks by the level of annual gross income.
Groups of insured persons and features of payments
The project provides for state subsidization of insurance premiums. To balance risks, it is recommended to be guided by three main factors: age, income, obstacles.
Depending on age, the insurance premium is fully subsidized by the state for people under 18 and people aged 63 and older.
Depending on the size of income, it is proposed to subsidize persons with such an income for whom the execution of the insurance contract can have a significant impact on their life and the life of their family. In this regard, it is also planned to apply a subsidy tool for certain groups of the population based on the policy of social support and employment promotion conducted by the state. It is planned that the use of a subsidy tool or income tax compensation will also contribute to the implementation of a system for declaring income of individuals.
The policy of full or partial subsidization due to obstacles is associated with the introduction of a new system for assessing human functional capabilities. It is expected that by 2027, all those citizens with disabilities who undergo a functional assessment will be fully subsidized, which will also allow identifying the health needs of individuals and purposefully responding to these needs by organizing appropriate services.
It is planned that starting in 2026, the cost of compulsory medical insurance in Armenia will be about 120,000 - 164,400 drams.
As one of the co-authors of the concept for the introduction of the IUD, Samvel Kharazyan, previously reported in an interview with ArmInfo, a system of subsidies for people with low incomes will be in effect: the state is ready to subsidize insurance premiums in the amount of up to 60% of the cost of the policy for individuals with a monthly income of no more than twice the minimum wage. The subsidy for individuals with a monthly income in the range of 150-300 thousand drams (gross salary) will be 40%. And those with higher incomes will have to pay the contributions themselves in full. A subsidy of 20% is also provided for each person affiliated with the insured person (family members) in the event of joining the system.
Insurance package expenses subject to full or partial compensation
According to the draft law, the following expenses for medical care and maintenance are subject to insurance compensation:
1) expenses for vaccinations in accordance with the national vaccination calendar, determined by the law against diseases or conditions, including research and consultations on their prevention, early detection and diagnosis;
2) medicines and medical supplies, laboratory and instrumental research, professional consultations, operations, surgical and fixing means, other therapeutic interventions, including physiotherapy, the use of oxygen and other gases used in medicine, postoperative measures and consultations carried out for the purpose of treatment in inpatient or outpatient settings, expenses for providing care to patients by ward, middle and junior medical personnel.
3) expenses for emergency medical care, including air medical care, that is, urgent transportation of patients by air or other types of transport, as well as expenses for transporting patients to a specialized medical organization;
4) expenses for medicines and medical supplies, laboratory and instrumental studies, professional consultations and other medical measures, including physiotherapy, carried out for the purpose of continuous out-of-hospital (dispensary) monitoring of chronic diseases and conditions; 5) expenses for limbs, joints, organ prostheses, metal structures.
Projected implementation costs
In 2024, it was planned to allocate 18 billion drams for the implementation of the system, this year the figure is projected at 1.8 billion drams, in 2026 the figure will reach 235.6 billion drams, and in 2027 - 268.4 billion drams. In 2028, the costs will approximately reach 4% of GDP.
It is expected that after the implementation, actuarial calculations should be carried out, based on the results of which the government will be able to submit proposals for changing the amount of the insurance premium.
