Learn about the new health insurance system
Learn about the new health insurance system # Universal Health Insurance System in Egypt: The Comprehensive Guide Learn about the new health insurance system Egypt health insurance
The universal health insurance system is a mandatory social solidarity health system in Egypt, operating in accordance with Law No. 2 of 2018, which stipulates that comprehensive social health insurance is a mandatory system, based on social solidarity, and its umbrella covers all Egyptian citizens and legal residents in Egypt.
How to register in the universal health insurance system?
Bring the national ID
Your wife
and children's birth certificates
Take the family closer
Primary Care Unit
Data logging and opening
Family Medical Profile
How to benefit from the universal health insurance system?
Linking with your family doctor
After registering in your primary care unit, you and your family will be tied to your family doctor.
Family Doctor's Examination
Call 15344 to book an appointment with your family doctor in case you need a check-up
Initial examination and treatment
You will be examined by your family doctor and will provide you with primary care service in addition to radiology, tests and medications.
Consultant examination
If the case is required, you will be referred to a specialist or consultant to diagnose your condition and dispense the appropriate treatment.
Hospitalization
In case you need hospitalization, the consultant will refer you for appropriate treatment.
- The system covers primary health services, diagnostic treatment services and emergency cases.
- The State shall bear the treatment and contributions of the unable and exempt them from contributions to treatment.
- The percentage of the citizen's contribution to the cost of operations is 5%, with a maximum of 300 pounds only, regardless of the cost of the surgery.
- The percentage of the citizen's contribution to the price of radiology and analyzes is 10%, with a maximum of 750 pounds at a time.
- The percentage of the citizen's contribution to the price of medicines is 10%, with a maximum of 1000 pounds at a time.
- People with chronic diseases and tumors are exempted from the percentage of contribution to treatment.
- Citizens benefit from the health insurance systems available in the country until the comprehensive health insurance system is implemented in their governorates.
Benefits of the Universal Health Insurance System in Egypt
The universal health insurance system offers many benefits to citizens and residents of the Egypt, including:
Provision of health care
The comprehensive health insurance system covers basic, emergency and diagnostic health care services, and provides citizens with the necessary health care without the need to pay high expenses.
### Improving the quality of health care
The universal health insurance system contributes to improving the quality of health care in the Egypt, where health care is provided at a high level of quality and professionalism.
### Reduction of injuries and diseases
The universal health insurance system contributes to reducing the spread of diseases and injuries, by providing appropriate health care and preventing diseases.
### Reducing the burden on the poorest
The universal health insurance system bears the costs of treatment and health contributions for the poorest groups, which reduces the burden on them and contributes to improving their social conditions.
What is the universal health insurance system?
It is a social solidarity system through which we provide high-quality medical services to all segments of society without discrimination, and the state undertakes to bear its burdens for those who are unable to reduce disease rates and provide therapeutic protection for all citizens.
What medical services are covered by comprehensive health insurance?
The comprehensive health insurance system covers all the necessary medical services for beneficiaries and their families from the first initial medical examination through laboratory tests, radiology, medicines, dental treatment, oncology, emergency and surgical operations.
Who is eligible for universal health insurance services?
All Egyptians are entitled to benefit from universal health insurance services in the governorates where the system is applied, provided that contributions are paid and coverage starts from birth to death without a maximum age limit.
Is the law mandatory for all citizens of the Republic of Egypt Arabic?
The law is mandatory for all citizens inside the Republic of Egypt Arabic, and optional for Egyptians working abroad and residing with their families abroad.
What is the purpose of universal health insurance?
The system aims to reduce poverty and disease rates by transferring the financial burden resulting from the occurrence of the disease from the individual income of the citizen to a strong financial system that has the financial ability to bear this burden, and work to provide full medical protection for the family in exchange for paying contributions to the able family, as for the unable family, the public treasury bears the financial burden of health coverage on behalf of those families, which helps the citizen avoid facing large spending on health for him and his family, which leads to improving the living Citizens.
Why the change in the current health insurance?
Because Egyptians have the right to live a healthy and safe life through an integrated health insurance system capable of achieving comprehensive health coverage and early intervention against diseases and injuries for all citizens to ensure financial protection for those who are unable to do so, and this change was necessary because of the inability of the previous health insurance to provide insurance coverage for all citizens, especially those who are not covered and are unable to, irregular workers, employers, university students and the rest of the family members subject to the health insurance system in force.
The separation of financing from service provision in the universal health insurance system is one of the most important factors that lead to improving the quality of service, raising the efficiency of performance, having real accounting, and achieving the response of service providers to the needs and expectations of citizens, as the new system is based on purchasing health care service from all health care service providers.
What is the difference between current health insurance and universal health insurance?
The current health insurance covers groups up to 50% of citizens, while universal health insurance will cover all citizens.
As the current health insurance is the individual is the unit of insurance coverage, while universal health insurance is the whole family is the unit of insurance coverage.
What is the relationship between the current health insurance and the comprehensive health insurance in the transitional period until its application to all governorates of the Republic?
As soon as the comprehensive health insurance system enters the governorate:
Health coverage will be provided to all citizens in this governorate, and to enjoy all treatment services for all family members, noting that the package of health services and benefits provided in this new system is not less than the package provided in the current health insurance system.
There will always be integration in the provision of health care between the two systems, and in the event of illness for the insured while he is in another governorate outside the application system, the commitment will be made to provide health service and treatment through the contract of the Universal Health Insurance Authority with the network of accredited health service providers in this governorate.
New contributions for the whole family will be collected in favor of the universal health insurance system and will not be paid again as a percentage of social insurance contributions.
What are the conditions for benefiting from health insurance services?
The beneficiary of the comprehensive health insurance system must be a participant in the system and a contributor or one of the unable for whom the public treasury bears the burden of contributions, and if he does not participate or fails to pay, his use of the comprehensive health insurance services shall be linked to the payment of late contributions in one payment or in installments, except in emergency cases.
Is there an exception to the application of the universal health insurance system?
Universal health insurance is a symbiotic system, meaning that the rich take care of the poor, the healthy sponsor the sick, and the productive citizen sponsors the unproductive, and therefore it is a mandatory system for all citizens of the Republic of Egypt Arabic.
Does the universal health insurance system apply to Egyptians working abroad?
Universal health insurance is optional for Egyptians working abroad as well as those living with their families abroad.
Who is responsible for implementing the universal health insurance system?
The universal health insurance system is managed by three public bodies:
Universal Health Insurance Authority: It manages and finances the purchase of health services provided to subscribers to the system.
Health Care Authority: Hospitals, units and centers of public sector service providers.
Health Accreditation and Control Authority: It aims to ensure the quality of health services and is responsible for granting licenses to entities involved in providing health service in hospitals.
Will the current treatment systems, such as the treatment system at the expense of the state, be abolished with the application of the Universal Health Insurance Law?
These regulations shall be abolished in each governorate in which universal health insurance is applied, and the total cancellation shall be effected with the generalization of the application of the system to all governorates of the Republic.
Is it permissible to provide comprehensive health insurance service to foreigners residing or expatriates in the Republic of Egypt Arabic?
The service may be provided to foreigners residing or expatriates of the Republic of Egypt Arabic in accordance with the controls and requirements set by the Comprehensive Health Insurance Authority, taking into account the condition of reciprocity.
What benefits do citizens and their families receive through the universal health insurance system?
All the following health insurance services:
Family doctor and general practitioner.
Specialist doctors, including dentistry and surgery.
Treatment, hospitalization, surgeries and other types of treatment.
Imaging and laboratory diagnostic services.
Rehabilitation services and disbursement of prosthetic devices.
Dispensing medications.
Home medical care where appropriate.
Travel for treatment abroad (according to the relevant regulations).
Dispensing medicines for tumors and chronic diseases for free.
What services are not covered by health insurance?
Public health and mental health services, preventive services, ambulance services, family planning services, and health services for covering disasters and epidemics, and the State is committed to providing these services free of charge.
What is the guarantee of the quality of the health service provided and the quality of treatment?
The Health Accreditation and Control Authority ensures the quality of health care and conforms to accreditation standards before allowing service delivery units to contract with the Universal Health Insurance Authority, and follows up on performance after contracting to ensure continuity in providing quality health service.
The Comprehensive Health Insurance Authority also has the right to exclude any of the system service providers from the records prepared for this purpose in the event that it is proven that he has failed or violated the level of medical care prescribed by the requirements of the Comprehensive Health Insurance Law or did not comply with the standards and requirements of the Accreditation and Control Authority, in addition to the existence of fair and rewarding pricing for medical services to ensure that the patient receives quality health service without resorting to additional procedures.
The citizen has the right to submit a complaint about his dissatisfaction with the level of service to the Health Accreditation and Control Authority and also to the Universal Health Insurance Authority.
Who are the incapable?
There is a committee formed from the Ministry of Finance, the Ministry of Social Solidarity and the Central Agency for Public Mobilization and Statistics to define the unable in accordance with the specific standards and controls issued by the Prime Minister's decision, provided that the state sponsors 30-35% of citizens at the level of the Republic.
Does the universal health insurance system include people with special needs?
Through the comprehensive health insurance system, the State is obligated to pay the contribution of the insured from the categories of the incapable, including those with special needs whose families do not have an adequate source of income.
Does universal health insurance apply to entities that have private health insurance such as taxes, customs, electricity, banks, and the Suez Canal Authority?
Yes, the comprehensive health insurance system is applied to these entities, as according to the text of Article 10 of the Comprehensive Health Insurance Law No. 2 of 2018, the Comprehensive Health Insurance Authority is obligated to purchase the health service for the owners of insurance systems or private health programs, whether the service is provided in the hospitals of the Health Care Authority or in the hospitals of those systems, in accordance with the contracting systems, prices, controls and procedures of the Universal Health Insurance Authority, as well as the quality standards determined by the Health Accreditation and Control Authority.
What is the role of private health insurance for owners of private health insurance schemes or programs?
Private health insurance companies will play an essential role, covering all complementary and hotel services that are not covered by the health services package of the comprehensive health insurance system.
What are the ways to provide the service with the comprehensive health insurance system?
The patient first goes to the family doctor or general practitioner in the primary care units of the citizen or family on which he has previously registered himself or his family, where the family doctor or general practitioner plays his role in providing the necessary health services according to the nature of the case, and referral is made to the higher levels of health care when needed, as well as with the citizen's freedom to choose a health service provider at the highest levels of health care among the health service providers in the public and private sectors. and university and military.
What are the steps and papers required to register in the comprehensive health insurance system?
The individual and all members of his family go to the nearest health unit or family medicine center to conduct a comprehensive examination for himself and his family with identity documents (valid national ID card - mechanized birth certificates of children)
A medical file is opened for the family with all the data, health history and disease, as well as the medicines that have already been or are still obtained, where a code is made for each citizen.
The family's data is recorded on the database so that its members can visit the unit to detect and obtain medicine and other medical services
Regular groups subject to the Social Insurance Law must submit a statement of family members (family registration) to the administrative unit to which they belong to determine the contributions due from them.
As for the categories not subject to the social insurance laws, they must apply to the Authority for family registration documented with the documents indicating it, and self-payment of contributions.
For those who are unable to, the State pays the contributions on their behalf.
What are the procedures in case of a change in the social status of the family?
The head of the family goes to one of the outlets of the Universal Health Insurance Authority to submit the necessary papers and amend the family data by modifying the status (example: marriage / divorce or work / marriage of one of the dependents) or addition (example childbearing) or deletion (such as death)
Accordingly, contributions and insurance coverage are adjusted to include all family members.
Are there cases where she can be allowed to travel abroad for treatment?
Yes, if it is necessary and it is impossible to treat the case through the services provided within the Republic of Egypt Arabic, treatment is taken care of abroad through health reports prepared by specialists in various specialties.
Is the insured entitled to be treated in units that are not contracted with the Universal Health Insurance Authority?
The insured has the right to treatment in units not contracted with the Universal Health Insurance Authority if his illness is emergency and has the character of urgency, so that the delay in providing the treatment service cannot be delayed, and he has the right to recover the costs of his treatment, all in accordance with the rules and procedures issued by the Universal Health Insurance Authority.
The contribution of a non-working woman is 3% and the contribution of each child is 1% of the father's total income
| The father's income is five thousand pounds according to case No. (1) |
| Total | 1% | 1% | 3% | 1% |
| 300 | 50 | 50 | 150 | 50 |
Case number 2:
Single employee subscription will be paid a contribution of 1% of his total monthly income
| The employee's income is five thousand pounds according to case No. (2) |
| Total | 1% |
| 50 | 50 |
Case number 3:
Any employee married to a non-working woman will pay a contribution of 4% of his gross monthly income
| The husband's income is five thousand pounds according to the case and the wife does not work according to case No. (2) |
| Total | 3% | 1% |
| 200 | 150 | 50 |
Case number 4:
In the event that the wife is a worker, the contribution is 1% of the husband's total income and his wife's contribution is paid 1% of her income
| The husband's income is five thousand pounds and the wife works and her income is three thousand pounds according to case No. (4) |
| Total | 1% | 1% |
| 80 | 30 | 50
|
What is the contribution rate of the insured subject to the Social Insurance Law No. 108 of 1976, as well as members of the liberal professions (free lawyer - free engineer - free doctor - tourist guide) as well as Egyptians working abroad?
5% of the insurance wage or wage is paid according to the tax return or the maximum insurance wage, whichever is greater, in addition to 3% for the wife who is not working or who does not have a fixed income, 1% for each dependent or child.
What is the percentage of contribution of workers subject to the Social Insurance Law promulgated by Law No. 112 of 1980 for seasonal and irregular workers (agricultural workers - street vendor - or craftsman) who do not have regular salaries?
Only 5% of the insurance wage is paid in addition to 3% for the wife who is not working or who does not have a fixed income, 1% for each dependent or son, so that the total amount paid by the individual for the whole family does not exceed 7%, and the public treasury bears the cost difference in case it exceeds that.
What is the percentage of contribution of the widow entitled to the pension?
2% of the monthly pension is deducted.
What is the contribution rate of pensioners?
2% of the monthly pension is deducted in addition to 3% for the wife who is working or does not have a fixed income, 1% for each dependent or child.
What is the employer's share of his employees in the application of universal health insurance?
The employer's share is 4% (3% sickness insurance, 1% work injuries) for sickness, treatment and work injury services of the total contribution wage for insured workers in accordance with the provisions of Law No. 79 of 1975 with a minimum of fifty pounds per month.
What are the contribution rates of the unable to the universal health insurance system?
The Public Treasury shall pay the contribution for the categories of those who are able, as well as each dependent family member, and the Public Treasury shall bear 5% of the minimum wage announced by the government at the national level per month for each of them.
What is the position of compulsory recruits and their families towards monthly contributions in the universal health insurance system?
The families of conscripts shall be compulsorily exempted from monthly contributions, provided that the conscript pays the contribution until joining the military service for himself and his dependents, provided that the contributions are paid upon receiving the services specified by law, and the public treasury bears the cost of health insurance for the families of conscripts.
The families of conscripts shall be compulsorily exempted from monthly contributions, provided that the conscript pays the contribution until joining the military service for himself and his dependents, provided that the contributions are paid upon receiving the services specified by law, and the public treasury bears the cost of health insurance for the families of conscripts.
Is there a maximum contribution limit for the insured?
There is no maximum limit for contribution, except for workers subject to the Universal Health Insurance System Law promulgated by Law 112 of 1980, the contribution difference shall be borne by the State Treasury.
What is the contribution rate in case the insured combines more than one job?
In the event that the insured works for more than one employer, all he receives from each employer shall be considered as the contribution wage.
What is the percentage of contribution of the insured who is on internal or external secondment, special or unpaid study leave?
The insurer shall bear his share and the employer's share for the periods of internal or external secondments and unpaid special or study vacations and shall supply them to the Authority except:
Child care leaves in accordance with the Child Law promulgated by Law No. 13 of 1996.
Scholarships, special study leaves and scientific tasks granted in accordance with the provisions of the Law Regulating the Affairs of Scholarships, Study Leaves and Grants No. 112 of 1959 or the Universities Organization Law promulgated by Law No. 49 of 1972, so the sending party, envoy or student shall bear the share of the worker and the employer, as the case may be.
Secondment to the units of the administrative apparatus in the State, and the borrowing party shall bear the employer's share.
What is meant by the contribution wage deducted from the insured?
It is all the monetary consideration received from one or more currency entities, in particular the following:
The wage stipulated in the tables attached to the employment regulations and the allowances included.
Incentives.
Official commissions.
Allowances except for the following allowances:
Transportation and travel allowance and other allowances paid to the insured in return for the burdens incurred by his job, with the exception of the representation allowance.
Housing allowance, clothing allowance, meal allowance, car allowance and other allowances paid in return for in-kind benefits.
Allowances are due to the insured to meet the burdens of living outside the country.
The value of the total excluded allowance shall not exceed 25% of the total wage of the insured.
Will there be fees or contributions when receiving the service? What is the method of collection?
Yes, some fees and limited contributions will be collected when receiving the health service for medicines, radiology, home visits, medical and laboratory analyzes and internal departments, and people with chronic diseases and tumors are exempted from these fees and contributions.
The collection will be done electronically through the electronic collection machines at the service outlets, using the "Meeza" cards, which are available for free at the National Bank, Egypt Bank, Banque du Caire, and the Agricultural Bank of Egypt. CIB until the first of November 2019.
Is the wage deducted in the case of a widowed wife and the children receive the pension for the deceased father?
1% of the comprehensive wage is deducted for the widowed working wife and 2% of the monthly pension for the children.
What happens if the marital status of one of the children changes after a month or more?
The database must be updated to reflect on the percentage of contributions that the head of the family is obligated to pay to those who live in his family, including children and dependents.
What is the position of a family that does not work in its entirety?
If it is proven that they do not have a source of income, the case is examined and registered among the incapable.
What is the position of employees in Port Said or subsequent governorates in which the comprehensive health insurance system has been applied? While the family's place of residence is in a governorate where the system has not yet been implemented?
The family will be covered by the comprehensive health insurance system according to the permanent place of residence, and accordingly, Port Said workers on a temporary basis are not insured they and their families with the comprehensive health insurance system, but workers will be covered by insurance against work injuries only.
What is the position of workers in governorates where the system has not yet been implemented? While the family's place of residence in Port Said Governorate or subsequent governorates in which the comprehensive health insurance system has been applied?
The family will be covered by the comprehensive health insurance system according to the permanent place of residence, and accordingly, workers outside the governorate and his family will be fully covered in the event that their permanent residence is proven Port Said or the governorate in which the system is applied.
In this case, the employer in the governorate is obliged, outside the scope of application, to collect comprehensive health insurance contributions only for his employees who have permanent residence in the governorate within the scope of application.
What is the attitude of the children of a wife who works in the case of an insured self-employed spouse as well as in the case of an uninsured self-employed spouse?
In the case of a self-employed spouse who is subject to insurance or is not subject to insurance, 5% of the insurance wage or wage according to the tax return or the maximum insurance wage, whichever is greater, and 1% for each child, while the working wife is deducted from her only 1% of the comprehensive wage.
Is the deduction made once or twice for a widow who receives a pension and depends?
Only widows are deducted 2% of the monthly pension.
What is the attitude of a working wife, the husband on pension, the children not working and uninsured?
1% of the working wife is deducted and 2% of the husband's monthly pension and 1% of the monthly pension are deducted for each child.
What is the situation for a family consisting of a working wife and a disabled husband who does not work and supports the children and mother of the husband, and is there an exemption for the 5% disability of the husband?
Its share, which represents 1% of the contribution wage, is deducted from 1% for each of the three children, while the rest is examined in their case due to the possibility of the public treasury bearing their share within the categories of the incapable.
Who will bear the children in the case of a divorced mother and a father on the pension?
Who bears the share of the father's children, as he deducts from him 1% of the monthly pension for each son in addition to his share, which represents 2% of the monthly pension.
Does the State guarantee a sick husband who does not work and does not have insurance and his wife who works?
In the case of the husband who is sick and does not work, his marital status is examined within the cases of the incapable, while the wife is deducted from her share, which represents 1% of her comprehensive wage.
How to register in the case of a wife who has an import card and the comprehensive health insurance contributions are deducted from her and is the deduction a second time with the husband and children?
Employers are deducted 5% of the insurance wage or from the wage according to the tax return or the maximum insurance wage, whichever is greater, and the deduction is not made again with the husband, while the husband, if he works, is deducted 1% of the comprehensive wage and 1% for each dependent or child.
What is the position for children's contributions in case of divorce?
Children are added to the father, where 1% of the monthly income is deducted from each of the children.
Who will bear the children's contributions in the case of the wife is an employee and the husband is one of the owners of (commercial registers - import card - or taxi driver)?
In this case, the husband shall bear the deduction from the children and the employed wife shall bear the percentage of the deduction for herself, and if it is impossible to collect the children's contributions from the husband, they shall be collected from the wife.
Does the mother bear the children in the event that the wife is employed and divorced and the husband is not insured?
Yes, where the employed wife is deducted from her share of 1% of her comprehensive wage to 1% for each of the children.
Who bears the universal health insurance contributions for children in the case of an employee whose husband is deceased and he was uninsured?
If the children have a pension, their contribution will be deducted from the pension at a rate of 1%.
An employee who has a quarter transport car registered in the name of his wife and insured and does not work to deduct from the husband the wife's percentage from his salary or from the car insurance?
The husband's share shall be deducted and the wife's share shall be deducted from the social insurance due from her as a result of her insurance as the owner and beneficiary of the vehicle.
If the father is self-employed and the mother is employed, will the children be tied with her and deducted from her?
If the husband is self-employed and insured, the children's share is deducted from the husband, and the wife can choose to register the children on her and deduct their contributions from her salary.
If the husband is not insured, does the wife bear it?
If he does not work, the wife shall bear for her husband and children.
In the event that an employee living in Port Said Governorate is transferred outside the governorate, will the comprehensive health insurance contribution be deducted from him or not?
He is deducted in accordance with the percentages contained in the Comprehensive Health Insurance Law, and in the event that he falls ill outside the governorate, he is treated in any hospital of his choice and has the right to recover the costs of his treatment in accordance with the service pricing regulation of the comprehensive health insurance system.
If a guardian registers his children at his workplace but the children work and are insured elsewhere, how is the father or the children accounted for and deducted at their workplace and are we counted on both?
The father is deducted from his share of his income, and the working children are deducted from their income and therefore there is no double deduction.
Is the representative of the Ministry of Finance tasked with opening a file with him to review the marital status of the employees of the entity in charge of financial supervision before paying the salary?
The Universal Health Insurance Authority shall establish a database in which the data of the beneficiaries shall be recorded, including all personal, functional, financial and health data necessary for the insured subject to the law, through a registration system in which the family is the subscription unit through a unified electronic form that includes all the data necessary for the application of the provisions of the law to ensure the supply of the Authority's database as necessary to carry out its function, and this form is the basis for dealing with the various competent authorities that have data on those subject to the law.
How is the employee obliged to write the names of his children with him on the form submitted at his workplace and not write his name only?
An acknowledgment and undertaking from the employee is written that the data contained in the form is correct and in the case of incorrect data, he is subject to legal accountability.
He will also not be able to benefit from the health service for his unregistered children until he has paid his arrears.
What is the wisdom of deducting 3% from a non-working wife?
As the wife who works is deducted from her 1% of the comprehensive wage and the employer's share is 4% (3% sickness insurance + 1% insurance against work injury) and therefore so that the difference is not too much between the share of the wife who works with the one who does not work.
The cost of such a system would also be very expensive, and ensuring the sustainability of funding is a key element in the success of this system.
In the event that the worker or employee is registered, the amount of comprehensive health insurance is deducted in a currency place and then form 6 is submitted, where is the insurance amount deducted in case of non-work?
In the first six months, social insurance will be paid on his behalf from the unemployment compensation due to him, and then, in the event that he continues to have no work, he and his family are registered among the incapable, for whom the public treasury bears the cost.
Companies contracting with medical care companies, what is required of them?
The comprehensive health insurance system is mandatory Therefore, companies contracting with medical care companies must commit to participating in the new system, and the Comprehensive Health Insurance Authority is committed to purchasing the health service for the owners of insurance systems or private health programs, whether the service is provided in the hospitals of the Health Care Authority or the hospitals of those systems, in accordance with the contracting systems, prices, controls and procedures of the Universal Health Insurance Authority, as well as the quality standards determined by the Health Accreditation and Control Authority.
In the event that there are some hotel or complementary services that are not covered within the health services package, private medical care companies can continue to be contracted to provide these services.
Is the Takaful contribution paid by companies as taxes allocated to the universal health insurance system deducted from the employer's contribution share for his employees?
The comprehensive health insurance system is a symbiotic social system, and therefore the Takaful contribution of companies is not considered within the employer's contributions for his employees, but rather a community contribution to support the new system.
Law and Executive Regulations
Universal Health Insurance System Law and Executive Regulations
