MoLVT Prakas 184 Amendment of PK 109 on Health Care Benefits
Prakas on the amendment of article 2, article 4, article 5, article 6, article 7, article 8 and article 10 of the Prakas No. 109 កប/ប្ប.ក dated on 17th -Mar, 2016, on the Health Care Benefits
MINISTER OF MINISTRY OF LABOUR AND VOCATIONAL TRAINING
- Having seen the Constitution of Kingdom of Cambodia;
- Having seen the Royal Kret No. NS/RKT/0913/903, dated 24 September 2013, concerning the Nomination of Royal Government of Kingdom of Cambodia;
- Having seen the Royal Kret No. NS/RKT/1213/1393, dated 21 December 2013, concerning the Revision and Addition of the Compositions of Royal Government of Kingdom of Cambodia;
- Having seen the Royal Kram No.02/NS/94, dated 20 July 1994, promulgating the Law on the Organization and Functioning of the Council of Ministers;
- Having seen the Royal Kram No. NS/RKM/0105/003, dated 17 January 2005, promulgating the Law on the Establishment of Ministry of Labour and Vocational Training;
- Having seen the Royal Kram No. CHS/RKM/0397/01, dated 13 March 1997, promulgating the Labour Law;
- Having seen the Royal Kram No. NS/RKM/0902/018, dated 25 September 2002, promulgating the Law on the Social Security Schemes for Persons Defined by the Provisions of the Labour Law;
- Having seen the Royal Kret No. NS/RKT/0815/872, dated 08 August 2015, concerning the Judicial Statute of the Public Administrative Establishment;
- Having seen the Sub-Decree No. 283 SD.E, dated 14 November 2014, concerning the Organization and Functioning of Ministry of Labour and Vocational Training;
- Having seen the Sub-Decree No. 16 SD.E, dated 02 March 2007, concerning the Establishment of the National Social Security Fund;
- Having seen the Sub-Decree No. 01 SD.E, dated 06 January 2016, concerning the Establishment of Social Security Schemes on Health Care for Persons Defined by the Provisions of the Labour Law;
- Reference to the proposal of the Board of Director of NSSF.
The Article 2, Article 4, Article 5, Article 6, Article 7, Article 8 and Article 10 of the Prakas No. 109 កប/ប្ប.ក dated on 17th -March 2016, on the Health Care Benefits hereby amended as following:
Article 2 (new)
Key terms used in this Prakas are as follow:
- Healthcare Benefit refers to the insurance scheme providing the health benefit packages and the defined health prevention services.
- Health Benefit Packages refers to medical care, delivery service, corpse transportation service, and daily allowance.
- Health Prevention Service refers to the on-time diagnosis, the identification of persons with health risk and specific health issue, consultation, and other necessary interventions with a view to preventing from health problems composed of screening, health education, and vaccination program.
- Medical Treatment and Care Services refers to medical service, para-clinic service, and medical assistance service.
- Medical Service refers to outpatient and inpatient consultation.
- Para-clinic Service refers to laboratory and medical imagery.
- Medical Assistant Service refers to physiotherapy and kinesitherapy.
- Medical Profession Technics refers to the methods of diagnosing and medical care provided by health professionals graduated from health sector, registered in the Medical Council of Cambodia, and licensed to run medical profession by Ministry of Health.
- Rehabilitation refers to medical care under the Healthcare Scheme 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.
- Surgery refers to scientific operation in purpose of treatment.
- Health Facility refers to the public or private health facilities recognized by Ministry of Health.
- Maternity refers to prenatal and postnatal leave.
- Outpatient Consultation Service refers to the examination and consultation excludes hospitalization.
- Delivery of a baby refers to the pregnancy period that has more than 26 weeks of age according to health basis.
- Daily Allowance refers to among of money provided for a period of absence from work resulting from illness, incidents or maternity leave.
- Self-treatment refers to the treatment without the medical prescript from a doctor who has entered into agreement with NSSF, except the case of emergency.
- Artificial Eye Contact Assistances refer to eye glasses or contact lens.
- Essential listed medicine refers to medicine in the Essential listed medicine has been set out by the Ministry of Health for the public health facilities.
- Representative of the injured person or patient refers to relatives or spouse of the patient.
Article 4 (new)
The excluded services in the medical care are:
- Free services as stipulated in the public health policy
- Dental care (teeth cleaning, teeth filling, and teeth implant)
- Sexual surgery and care
- Organ transplantation
- Artificial fertilities
- Plastic Surgery
- Aid artificial eyes tools and laser-therapy
- Alcoholism treatment and Drug abuse treatment
- Barren treatment
- Artificial glow surgery
- Coronary and heart surgery
- Cancer treatment by Chemotherapy
In case of the emergency, all services mentioned above still be granted.
Article 5 (new)
Chronic disease services treatment shall be provided within the public health facilities and with essential drug only. For the drugs are not in the essential drug list shall be borne by the patient, provided that drugs for the curement of diabetes and hypertension disease which do not exist in the essential drug list and the curement of cancer by the chemical substances shall be paid upon each service.
Article 6 (new)
6.1 In order to gain the medical treatment and medical care services, the workers shall fulfill the following conditions:
a. Working in the enterprises/establishments registered in the National Social Security Fund for Healthcare Scheme and is holding NSSF’s membership card even though the employer has not paid for the contribution rate for the initial month to NSSF.
b. Paid contribution for Health Care Scheme in a qualifying period of at least 6 (six) months within a period of the last 12 (twelve) months until encountering the health problems or maternity.
In case the NSSF member has already paid the contribution in a qualifying period of 2 (two) consecutive months; unfortunately, they have no responsible to pay the contribution, those NSSF members still have an entitlement to the medical care services in a qualifying period of 2 (two) consecutive months more from the date of having no responsible to pay the contribution of person concerned.
6.2 In order to obtain the daily allowance, the workers shall fulfill the following conditions:
- Have paid for the contribution for Health Care Scheme in a qualifying period of 2 (two) consecutive months or have paid for a qualifying period of 6 (six) consecutive months in the period of last twelve (12) months until encountering the health problems and still working;
- Have paid for contribution at least in a qualifying period of 9 (nine) consecutive months of maternity month
Article 7 (new)
7.1 The workers who have fulfilled the conditions as set forth in point 6.2 of Article 6 in this Prakas shall be eligible to:
- Free treatment in the health facilities recognized by NSSF not exceed 180 (one hundred and eighty) days within 12 (twelve) months including inpatient service in the hospital.
- 70% of daily allowance of workers’ daily average wage for a period of abstention from work due to treatment with prescription for over 7 (seven) consecutive days since the first day that workers have accessed to the health facilities. This daily allowance is provided not exceeding 180 (one hundred and eighty) days in the last 12 (twelve) months by excluding the maternity leave 90 (ninety) days
- 70% of daily allowance of workers’ daily average wage in a qualifying period of 90 (ninety) days for prenatal and postnatal leave.
7.2 Patient or injured worker and corpse transportation service
- Patient referral service shall be granted in case of the emergency and with ambulance of health facilities or other means with a certified letter.
- The serious disease that is untreatable or corpse transportation shall be provided based on the price of health facilities recognized by NSSF and other means of transportation.
Article 8 (new)
8.1 Average wage is a division on average of the assumed wage in a qualifying period not exceed 6 (six) months prior to the date of health problems or the delivery of baby. The assumed wage shall be determined in the table as set forth in Annex 1 in this Prakas.
8.2 Daily average wage is a division of average wage as stipulated in point 8.1 and 30 (thirty) days. 8.3 The calculation of average wage determined in this Prakas shall be affected the social security benefit calculation only.
Article 10 (new)
10.1 The NSSF member shall consume the health service in the health facilities signed the agreement with NSSF. The National Social Security Fund will take a responsibility for service payment as determined in the health benefit package. If the NSSF member utilizes the services in the health facilities not recognized by NSSF, NSSF shall reimburse in case of the emergency only. The benefit claim shall be followed the form “Medical Care Benefit” or form “4.02” as set forth in Annex 2 in this Prakas. Formality of benefit claim shall be enclosed herewith the medical documents and other receipts as well as the relevant necessary documents.
10.2 The claim of daily allowance shall be done by the patient or representative complying with the form “Daily Allowance” or form “4.03” as stipulated in Annex 3 in this Prakas. The formality of benefit claim shall be enclosed herewith the discharged letter issued by the health facilities recognized by NSSF in which the patient consumes the medical care services. The permission letter issued by the enterprises/establishments’ medical doctor shall be agreed upon from employer or representative of the enterprises/establishments.
10.3 The entitlement of medical care benefits and daily allowance are valid in a qualifying period of 12 (twelve) months starting from the first day of encountering health problems.
This Prakas shall be effected from the signing date onward.
See the Unofficial translation by CAMFEBA here