The launch of social security scheme Phase II on Health Care was issued in the Rectangular Strategy Phase III of the Royal Government and established by Sub-Decree No. 01 SD.E, dated 06 January 2016, concerning the Establishment of Social Security Scheme on Health Care for Persons Defined by the Provisions of the Labour Law. The implementation of social security schemes on Occupational Risk and Health Care is two consistent mechanisms because health prevention of workers shall not only receive disease or injury treatments due to work but also include the prevention of personal health or non-work injury. The implementation of both schemes is a mutual connection and has a comprehensiveness to protect workers. This Health Care Scheme has contributed to provide the health promotion and the health prevention for workers.

  1. Health Care Scheme

Health Care Scheme refers to social health insurance including benefit provision, health prevention, medical care services, provision of daily allowance for the abstention from work due to sickness or other accidents in the exemption of work injury and maternity leave.

  1. Contribution Payment and Contribution Rate

Employers and workers 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 scheme to NSSF until 31 December 2017.

Contribution payment of health care scheme as set forth in the above paragraph shall be borne by employer from 01 January 2018 onwards.

  1. Health Care Benefits

       Health care benefits refer to health care package and health prevention services.

       3.1. Health care package refers to medical care services, patient or victim referral service and copse transportation, and daily allowance.

  1. Medical Care Services

A.1. In-patient service

  • 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
  • Patient room (based on the actual situation of health facility).

A.2. Outpatient services

  • 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

  • refers to any interventions performed in an unexpected occasion and with the purpose of resuscitation or prevention of any limb or organ loss of victim or patient.
  • Patient or victim is entitled to access medical care services in the nearest health facilities. NSSF will reimburse the patient or victim by case-based or fee-for-service payment only if the victim or beneficiary informs NSSF in a period of 48 (forty-eight) hours via Hotline: 1286.

A.4. Kinesitherapy and Physiotherapy refers to medical assistant services.

A.5. Delivery and Prenatal and Postnatal Care.

A.6. 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.

  1. Patient or Victim Referral Service and Corpse Transportation

B.1. Patient referral service shall be granted in case of the emergency and with ambulance of health facilities only.

B.2. Hopeless patient or corpse transportation shall be provided based on the price of health facilities recognized by NSSF.

  1. Daily Allowance shall be granted in a period of abstention from work duet to sickness, accident, maternity leave, or other accidents with medical care services free of charge as set forth in the public health policy. 70% of daily allowance of daily average wage shall also be provided to the patient or victim.

3.2. Health Prevention

refers to the punctual diagnosis, persons with health risk and ill-health identification, consultation, and other necessary interventions with a view to preventing from health problems composed of screening, health education, and vaccination program. Health prevention service shall be provided by the National Social Security Fund, national programs, institutions, and relevant organizations involved with health.