Services provided by the comprehensive health insurance system for patients

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The Comprehensive Social Health Insurance Law promulgated by Law No. 2 of 2018 stipulates that comprehensive social health insurance is a compulsory system, based on social solidarity, and its umbrella covers all citizens participating in the system, and the state bears its burdens for those who are unable, based on a decision issued by the Prime Minister to define controls Exemption, and the family is the main unit of insurance coverage within the system, and this system is based on the separation of financing from service provision, and the authority may not provide treatment services or participate in providing them.

According to Article (3) of the law, the system’s services include a set of insurance health services for all diseases that are provided to the insured inside the Republic, whether they are diagnostic, therapeutic, or rehabilitative services, or medical or laboratory examinations. The authority, based on the proposal of the relevant committees, may add other services to the services The aforementioned, taking into account the preservation of the financial and actuarial balance of the system.

The most prominent of these services:

1- The family doctor or general practitioner in the specified treatment areas

2- Specialized doctors, including those related to oral and dental medicine and surgery

3- Home medical care when required

4- Treatment and stay in a hospital or specialized center, conducting surgeries and other types of treatment

5- Medical imaging examination, laboratory examinations and other medical examinations and the like.

6- Rehabilitation services, physical therapy, and prosthetic devices in accordance with the basic lists issued by the authority’s specialized committees

7- Editing medical prescriptions and dispensing medicines and supplies needed for treatment according to the basic and supplementary lists issued by the authority’s specialized committees, as well as making the necessary medical reports

8- Primary and periodic medical examination for every job candidate to verify his health and psychological fitness

9- Treatment abroad for those who cannot be treated through the services provided inside the Arab Republic of Egypt and has treatment abroad, based on a report issued by a specialized committee in this regard and formed by the authority, and the executive regulations clarify its procedures and controls

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