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NSSF clears member confusion on extent of health insurance

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Citizens come to receive treatment services using NSSF card at the Phnom Penh Referral Hospital. Heng Chivoan

NSSF clears member confusion on extent of health insurance

In a bid to avoid confusion, the National Social Security Fund (NSSF) said medical check-ups are not included in its healthcare coverage as members can use NSSF only for treatment and medical care.

The clarification came as some NSSF members questioned NSSF-covered healthcare services at state and private hospitals after paying out of pocket for certain tests run by their physicians when having a check-up.

NSSF deputy director-general Heng Sophannarith said on October 18 that most of the members who used the NSSF healthcare services had basic misconceptions about what was and was not covered.

He explained that one reason why some members were confused is that the NSSF materials refer to treatment, and in this case treatment is only in response to active health conditions rather than preventive treatment.

NSSF members who did not actively have a given disease but wanted to be tested for it or pursue preventive measures would have to pay for that themselves, he explained.

“We insure them for treatment of the diseases already afflicting them. It means that when they develop a disease, they can go and receive treatment at a clinic or go to a hospital and see doctors through the NSSF programme,” he said.

Sophannarith noted that the government is considering providing all NSSF members with a package of health check-ups and follow-ups with preventive care options covered in the future with coverage purchased on an annual basis.

However, he emphasised that the project is only one possible path the NSSF may follow for future coverage options, but in any event the organisation will continue to work to improve its healthcare coverage overall.

The NSSF’s social health insurance programme allows members to receive treatment and medical care with set daily allowances over a period in which the employees are absent from work due to illness or some other accident, in addition to covering occupational hazards and maternal leave.

The NSSF programme covers treatment in hospitals as well as diagnosis, lab services and other medical examination services, with medicine and food provided by the health facilities included.

Its members could receive emergency services under any circumstances without advance planning, and medical interventions can be carried for the purpose of saving their lives or the loss of any limbs or other bodily harm.

“They can go and use their nearest medical services. We will reimburse them or the hospital in most cases for these services if the victim informs within 48 hours of seeking the care via the 1286 hotline,” Sophannarith said.

In addition to the insurance coverage, NSSF members will also receive a package of physical therapy services, including medical assistance, obstetrics and prenatal care, post-delivery care and referral services, along with coverage for accidents and funeral services as well.

As of October 2, a total of 466,725 members from over 13,300 businesses had registered with the NSSF, which also launched social security and pension schemes for the private sector earlier this year.

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