Compulsory social health insurance (OSHI) is a set of legal, economic and organizational measures to provide medical assistance to consumers of medical services at the expense of the assets of the social health insurance fund.
The right to medical care in the compulsory medical insurance system is granted to persons for whom deductions and (or) contributions to the fund were paid, as well as those exempt from paying contributions to the fund in accordance with paragraph 7 of Article 28 of the Law of the Republic of Kazakhstan “On Compulsory Social Health Insurance”.
OSMS is based on the principles:
1) compliance and execution of the legislation of the Republic of Kazakhstan on compulsory medical insurance;
2) the obligation to pay deductions and (or) contributions;
3) joint liability of the state, employers and citizens;
4) accessibility and quality of medical care provided;
5) use of the fund’s assets exclusively for the provision of medical care in the compulsory medical insurance system;
6) publicity of the fund’s activities.
Participants in the OSMS system are:
1) payers;
2) consumers of medical services;
3) healthcare subjects;
4) authorized body;
5) National Bank of the Republic of Kazakhstan;
6) fund;
7) State corporation;
8) other authorized bodies.
Payers in the OSMS system
Payers of contributions are employers, including foreign legal entities operating in the Republic of Kazakhstan through a permanent establishment, as well as branches, representative offices of foreign legal entities, calculating (withholding) and transferring deductions and contributions to the fund in the manner established by Chapter 6 of this Law.
Payers of contributions are:
1) state;
2) employees, including government and civil servants, with the exception of military personnel, law enforcement officers, and special government agencies;
3) individual entrepreneurs;
4) persons engaged in private practice;
5) individuals receiving income under civil contracts concluded with a tax agent in accordance with the legislation of the Republic of Kazakhstan (hereinafter referred to as individuals receiving income under civil contracts);
6) persons who independently pay contributions, including citizens of the Republic of Kazakhstan who have left the Republic of Kazakhstan (hereinafter referred to as independent payers), with the exception of employees, individuals receiving income under civil contracts, payers of a single aggregate payment, existing individual entrepreneurs, as well as citizens of the Republic of Kazakhstan who have left for permanent residence outside the Republic of Kazakhstan in the manner established by the legislation of the Republic of Kazakhstan, and citizens for whom deductions and (or) contributions are paid in the Republic of Kazakhstan;
7) individuals who are payers of a single aggregate payment in accordance with Article 774 of the Code of the Republic of Kazakhstan “On taxes and other obligatory payments to the budget” (Tax Code).
Payers of contributions are not foreigners and stateless persons, with the exception of persons permanently residing on the territory of the Republic of Kazakhstan and oralmans, unless otherwise provided by international treaties ratified by the Republic of Kazakhstan.
Consumers of medical services in the compulsory medical insurance system have the right to:
1) receiving timely and high-quality medical care;
2) selection of a medical organization in accordance with this Law.
NJSC "SOCIAL HEALTH INSURANCE FUND" (official website fms.kz)
The Fund is a non-profit organization in the legal form of a joint stock company, the sole founder and shareholder of which is the Government of the Republic of Kazakhstan.
The fund's assets are formed by:
1) deductions, contributions, penalties received for late payment of deductions and (or) contributions, investment income minus commission fees to ensure the activities of the fund;
2) other income to the fund not prohibited by the legislation of the Republic of Kazakhstan.
The fund's assets are placed on accounts opened with the National Bank of the Republic of Kazakhstan
The assets of the fund can be used exclusively for the following purposes:
1) payment for services of healthcare entities to provide medical care in the system of compulsory social health insurance;
2) placement in financial instruments, the list of which is determined by the Government of the Republic of Kazakhstan;
3) return of overpaid amounts of deductions and (or) contributions, other erroneously credited funds.