The analysis of Republic of Moldova’s Law No. 1585 on Mandatory Health Insurance, updated as of October 26, 2023, focuses on the main provisions, objectives, and implications of the mandatory health insurance system within the country.
The Mandatory Health Insurance (MHI) system is designed as a state-guaranteed, autonomous financial protection mechanism for the population. It operates on the principles of solidarity and equality, ensuring that all citizens and eligible foreign residents receive timely, high-quality healthcare based on their medical needs, regardless of their ability to pay upfront.
Objectives and Scope (Articles 1-3)
- Purpose: To provide financial protection for citizens in healthcare through a state-guaranteed mandatory health insurance system.
- Program Coverage: A unified health insurance program defines the services, conditions, and illnesses covered by insurance.
- Risk Protection: The insured risk includes healthcare costs for conditions defined under the Unified Program.
Stakeholders and Responsibilities (Articles 4-6)
- Stakeholders:
- The insured person, insured entity, insurer (National Health Insurance Company – CNAM), health service providers, and suppliers of medical goods.
- Government Role:
The government insures vulnerable populations (e.g., children, students, pregnant women, the disabled, pensioners, and war veterans) and maintains oversight. - Insurance Obligations:
Employed individuals pay premiums through their employers, while non-employed individuals can be covered by state contributions or pay fixed premiums individually.
Principles of Health Insurance (Article 5)
- Unicity and Equality: Ensures all citizens and foreign residents have access to services under equal conditions.
- Solidarity: Contributions are based on income, while services are based on healthcare needs.
- Transparency: All financial operations must be reported and made publicly available by CNAM.
Contracts and Service Provision (Articles 7-13)
- Contracts between the insurer and healthcare providers specify service obligations, costs, and performance standards.
- Providers are required to publish details about contracts, financial reports, and healthcare services offered.
- Providers must meet performance, quality, and geographic coverage standards to remain contracted with CNAM.
Rights and Obligations
- Insured Individuals (Article 11):
- Right to choose a family doctor and receive covered healthcare services across the country.
- Obligation to pay for services not covered by the Unified Program and ensure their registration with a family doctor.
- National Health Insurance Company (Article 12):
- Obligated to manage insurance funds transparently, monitor provider compliance, and protect insured persons’ rights.
Financial Aspects (Articles 16-17)
- Insurance Funds: The system includes five core funds for medical services, prevention measures, and administrative purposes.
- Premiums: Annual premiums are set based on either a fixed amount or a percentage of income.
- Exemption for IT Sector: Employees of IT park residents are subject to special tax exemptions, with contributions managed through a unique tax mechanism.
Dispute Resolution and Compliance (Articles 14, 20)
- CNAM has the authority to recover funds misused by providers or employers who fail to meet contractual obligations.
- Disputes are resolved through judicial proceedings.
Recent Amendments (LP302 of 26.10.2023)
- Updated provisions for premium payments, penalties, and government-covered insurance for unemployed beneficiaries have been introduced.
- Expanded the scope of vulnerable groups eligible for government-funded insurance.
