UMI to equally cover all insured persons - bill 

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.