"Egemen Kazakhstan " dated 11/19/2015, No. 222 (28700);" Kazakhstanskaya Pravda" dated 11/19/2015, No. 222 (28098); Gazette of the Parliament of the Republic of Kazakhstan, 2015, No. 22-I, Article 142; Reference Control Bank of the NPA of the Republic of Kazakhstan in electronic form, published 07/05/2016.
The Law of the Republic of Kazakhstan dated November 16, 2015 No. 405-V SAM.
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On compulsory social health insurance
Please note!
For the procedure for putting this Law into effect, see Article 41.
Contents
Note. Throughout the text, the words "oralmans", "oralmans" and "oralmans" are replaced, respectively, by the words "kandastar", "kandastar" and "kandastar" by the Law of the Republic of Kazakhstan dated 05/13/2020 No. 327 - VI (effective from the date of making appropriate amendments and additions to the Code of the Republic of Kazakhstan"On taxes and other mandatory payments to the budget" (Tax Code). additions are put into effect after the effective date).
This Law regulates public relations arising in the system of compulsory social health insurance in order to implement the constitutional rights of citizens to health protection.
Chapter 1. GENERAL PROVISIONS
Article 1. The basic concepts used in this Law
The following basic concepts are used in this Law:
1) The State Corporation "Government for Citizens" (hereinafter – the State Corporation) was established by decision of the Government of the Republic of Kazakhstan to provide public services in accordance with the legislation of the Republic of Kazakhstan, organize work on accepting applications for public services and issuing their results to the service recipient on the principle of "one window", provision of public services in electronic form a legal entity;
1-1) deductions-money paid by employers to the Social Health Insurance Fund at their own expense, granting the right to receive medical care in the compulsory social health insurance system to consumers of medical services for which deductions were paid;
2) payers of deductions and (or) contributions (hereinafter referred to as payers) – persons who calculate, withhold, transfer, pay deductions and (or) contributions to the Social Health Insurance Fund in accordance with the procedure established by this Law;
3) The Social Health Insurance Fund (hereinafter referred to as the fund) is a non-profit organization that consolidates deductions and contributions, as well as purchases and pays for services of healthcare entities providing medical care, in the amounts and on the terms provided for in the contract for the purchase of medical services, and other functions defined by the laws of the Republic of Kazakhstan;
4) the authorized body in the field of healthcare (hereinafter referred to as the authorized body) is a center that provides leadership and intersectoral coordination in the field of health protection of citizens of the Republic of Kazakhstan, medical and pharmaceutical science, medical and pharmaceutical education, sanitary and epidemiological welfare of the population, circulation of medicines and medical products, quality of medical services (assistance). the organ;
5) healthcare entities -healthcare organizations – as well as individuals engaged in private medical practice and pharmaceutical activities;
6) purchase of services from healthcare entities – planning, selection, conclusion and execution of a contract for the purchase of medical services;
7) contributions-money paid to the Fund by the payers of contributions specified in paragraph 2 of Article 14 of this Law and providing consumers of medical services with the right to receive medical care in the system of compulsory social health insurance;
7-1) a person engaged in private practice – a private notary, a private bailiff, a lawyer, a professional mediator;
7-2) investment income -an increase in the assets of the fund in monetary terms, obtained as a result of their investment;
8) assets of the fund - deductions and contributions, net of commission for ensuring the activities of the fund, penalties, investment income received for late payment of deductions and (or) contributions, as well as other income to the fund not prohibited by the legislation of the Republic of Kazakhstan;
9) the Joint Commission on the quality of medical services (hereinafter referred to as the joint commission) is an advisory body under the authorized body established to develop recommendations for improving clinical protocols, standards of medical education, drug provision, standards of the quality control system and accessibility of health services;
10) the contract for the purchase of medical services (hereinafter referred to as the contract for the purchase of services) is an agreement in writing between the fund and a healthcare entity providing for the provision of medical care within the guaranteed volume of free medical care and (or) in the system of compulsory social health insurance;
11) consumer of medical services - an individual who has the right to receive medical care in the system of compulsory social health insurance in accordance with this Law;
12) compulsory social health insurance - a set of legal, economic and organizational measures to provide medical care to consumers of medical services at the expense of the assets of the Social Health Insurance Fund;
13) the system of compulsory social health insurance is a set of norms and rules established by the state regulating relations between participants in the system of compulsory social health insurance;
14) medical care in the compulsory social health insurance system – the amount of medical care provided to consumers of medical services at the expense of the assets of the Social Health Insurance Fund;
15) excluded by the Law of the Republic of Kazakhstan dated 30.06.2017 No. 80-VI (effective ten calendar days after the date of its first official publication);
16) excluded by the Law of the Republic of Kazakhstan dated 30.06.2017 No. 80-VI (effective after ten calendar days after the date of its first official publication);
17) excluded by the Law of the Republic of Kazakhstan dated 12/23/2023 No. 50 – VIII (effective sixty calendar days after the date of its first official publication).
Note. Article 1 as amended by the Republic of Kazakhstan dated 30.06.2017 No. 80 - VI (effective after ten calendar days after the date of its first official publication); dated 12/25/2017 No. 122-VI (effective from 01.01.2018); dated 12/26/2018 No. 203-VI (effective after ten calendar days after date of its first official publication); dated 12/28/2018 No. 211-VI (effective ten calendar days after the date of its first official publication); dated 06/24/2021 No. 52-VII (effective after ten calendar days after the date of its first official publication); by Law No. 50-VIII dated 12/23/2023 (effective after sixty calendar days after the date of its first official publication).
Article 2. Scope of this Law
1. excluded by the Law of the Republic of Kazakhstan dated 30.06.2017 No. 80-VI (effective ten calendar days after the date of its first official publication).
2. Foreigners and stateless persons, as well as Candace permanently residing in the territory of the Republic of Kazakhstan, equally enjoy the rights and bear responsibilities in the system of compulsory social health insurance with citizens of the Republic of Kazakhstan, unless otherwise provided by this Law.
3. Foreigners and members of their families temporarily staying in the territory of the Republic of Kazakhstan enjoy rights in the compulsory social health insurance system and bear obligations on an equal basis with citizens of the Republic of Kazakhstan in accordance with the terms of an international treaty ratified by the Republic of Kazakhstan, unless otherwise provided by laws or international treaties.
Their family members are a cohabiting spouse and children of foreigners.
Note. Article 2 as amended by the Laws of the Republic of Kazakhstan dated 30.06.2017 No. 80 - VI (effective after ten calendar days after the day of its first official publication); dated 07.07.2020 No. 361-VI (effective after ten calendar days after the day of its first official publication).
Article 3. Legislation of the Republic of Kazakhstan On compulsory social health insurance
1. The legislation of the Republic of Kazakhstan On compulsory social health insurance is based on the Constitution of the Republic of Kazakhstan and consists of this Law and other regulatory legal acts of the Republic of Kazakhstan.
2. If an international treaty ratified by the Republic of Kazakhstan establishes rules other than those contained in this Law, the rules of the international treaty shall apply.
3. legal relations regulated by the legislation of the Republic of Kazakhstan On compulsory social health insurance are not subject to the legislation of the Republic of Kazakhstan On insurance and insurance activities.
Article 4. Principles of compulsory social health insurance
Compulsory social health insurance:
1) compliance with and enforcement of the legislation of the Republic of Kazakhstan On compulsory social health insurance;
2) the obligation to pay deductions and (or) contributions;
3) joint responsibility of the state, employers and citizens;
4) accessibility and quality of medical care provided;
5) the use of the fund's assets exclusively for the provision of medical care in the compulsory social health insurance system;
6) transparency in the activities of the foundation.
Article 5. The right to medical care in the compulsory social health insurance system