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The Comprehensive Social Health Insurance Act specifies the definition and description of the health insurance system and the unit of insurance coverage within the system, as well as the health and medical services that the system provides to policyholders.
The law states, in its article (2), that global social health insurance is a mandatory system, based on social solidarity, and its umbrella covers all citizens who participate in the system, and the state bears its burdens for those which are prevented on the basis of a Prime Minister’s decision defining exemption checks. It is the main unit of insurance coverage within the system and this system is based on the separation of funding from the provision of services and the Authority cannot provide care services or participate in providing them.
Under Article (3), the services of the system include a range of health insurance services for all diseases provided to insured persons within the Arab Republic of Egypt, whether they are diagnostic, therapeutic or rehabilitative services, or medical examinations or laboratory, and the Commission, on the basis of the proposal of the competent committees, may add other services to the services The above, taking into account the maintenance of the financial and actuarial balance of the system.
These services are provided through:
1- The family doctor or general practitioner in the specified treatment areas.
2- Specialized doctors, including those relating to oral and dental medicine and surgery.
3- Home medical assistance when needed.
4- Care and stay in a hospital or specialized center, conducting surgical interventions and other types of treatment.
5- Medical imaging examination, laboratory tests and other medical tests and the like.
6- Rehabilitation services, physical therapy and prosthetic devices according to the basic lists issued by the specialized committees of the authority.
7- Modification of medical prescriptions and distribution of medicines and supplies necessary for treatment in accordance with the basic and supplementary lists issued by the specialized committees of the authority, as well as the preparation of the necessary medical reports.
8- Primary and periodic medical examination for each job candidate to verify their health and psychological fitness.
9- Treatment abroad for those who cannot be treated through services provided within the Arab Republic of Egypt and have treatment abroad, based on a report issued by a committee specialized in the matter and formed by the authority , and the executive regulation clarifies the procedures and controls.
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