On approval of the Rules for recordkeeping of medical service consumers and granting the right for medical care in the system of compulsory social health insurance

New Unofficial translation

Order of the Minister of Healthcare of the Republic of Kazakhstan dated December 29, 2020, No. ҚР ДСМ-333/2020. Registered with the Ministry of Justice of the Republic of Kazakhstan on December 30, 2020, No. 21977

      Unofficial translation

      In accordance with subparagraph 66) of Article 7 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On public health and the health care system" I HEREBY ORDER:

      1. To approve the attached Rules for recordkeeping of medical service consumers and granting the right for medical care in the system of compulsory social health insurance.

      2. The Department for Coordination of Compulsory Social Health Insurance of the Ministry of Healthcare of the Republic of Kazakhstan, in the manner prescribed by the legislation of the Republic of Kazakhstan, shall ensure:

      1) state registration of this Order with the Ministry of Justice of the Republic of Kazakhstan;

      2) posting this Order on the Internet resource of the Ministry of Healthcare of the Republic of Kazakhstan after its official publication;

      3) within ten working days after the state registration of this Order, submission to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan of the information on the implementation of the measures provided for in subparagraphs 1) and 2) of this paragraph.

      3. Control over execution of this Order shall be assigned to the First Deputy Minister of Healthcare of the Republic of Kazakhstan Shoranova M.E.

      4. This Order shall come into effect from the day of its first official publication.

      Minister of Healthcare of the
Republic of Kazakhstan 
A. Tsoi

  Approved by Order of the
Minister of Healthcare of the
Republic of Kazakhstan
dated December 29, 2020
No. ҚР ДСМ-333/2020

The Rules for recordkeeping of medical service consumers and granting the right for medical care in the system of compulsory social health insurance

Chapter 1. General Provisions

      1. These Rules for recordkeeping of medical service consumers and granting the right for medical care in the system of compulsory social health insurance (hereinafter referred to as the Rules) have been developed in accordance with subparagraph 66) of Article 7 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On public health and the health care system" and shall determine the procedure for recordkeeping of consumers within the framework of the compulsory health insurance system (hereinafter referred to as the CSHI).

      2. The basic concepts used in these Rules:

      1) State corporation "Government for Citizens" (hereinafter referred to as the State corporation) - a legal entity created by the decision of the Government of the Republic of Kazakhstan for the provision of public services, services for the issuance of technical conditions for connecting natural monopoly entities to the networks and services of quasi-public sector entities in accordance with by the legislation of the Republic of Kazakhstan, organizing work on receiving applications for the provision of public services, services for issuing technical specifications for connecting to networks of natural monopoly entities, services of quasi-public sector entities and issuing their results to a service recipient on the principle of "one window", as well as ensuring the provision of public services in electronic form, carrying out state registration of rights to real estate at the place of its location;

      2) information exchange - the process of receiving and transmitting data from one information system to another;

      3) payers of deductions and (or) contributions (hereinafter referred to as Payers) - persons who calculate, withhold, transfer, pay deductions and (or) contributions to the Fund in the manner prescribed by the Law of the Republic of Kazakhstan dated November 16, 2015 "On compulsory social medical insurance" (hereinafter referred to as the Law);

      4) social health insurance fund (hereinafter referred to as the Fund) - a non-profit organization that accumulates deductions and contributions, as well as purchases and pays for the services of Healthcare entities that provide medical care in the volumes and on the conditions provided for by the contract for the purchase of medical services, and other functions defined by the laws of the Republic of Kazakhstan;

      5) information system of the Fund (hereinafter referred to as the IS of the Fund) - an information system that ensures the conduct of the processes of the Fund in electronic format;

      6) - consumer of medical services in the compulsory health insurance system (hereinafter referred to as a Consumer) - an individual who, in accordance with the Law, has the right to receive medical care in the compulsory health insurance system.

      3. In accordance with Article 5 of the Law, the right to medical care in the compulsory health insurance system shall be granted to persons for whom the payment of deductions and (or) contributions to the Fund, as well as those exempt from paying contributions to the Fund in accordance with paragraph 7 of Article 28 of the Law, have been made.

      4. Recordkeeping of consumers within the CSHI system shall be carried out by the Fund in the IS of the Fund based on data or information from the State corporation received from the information systems of state bodies of the Republic of Kazakhstan, data on military personnel, employees of special state and law enforcement agencies, submitted in electronic format.

      5. The exchange of data between the information systems of state bodies of the Republic of Kazakhstan, the IS of the Fund shall be carried out in electronic form via dedicated or open communication channels, including the Internet, in accordance with the requirements established by the legislation of the Republic of Kazakhstan on informatization, on state secrets and personal data protection. Information exchange is not subject to information constituting state secrets of the Republic of Kazakhstan, as well as official information of limited distribution.

      6. Data by category of consumers, except for the data provided for in Chapter 3 of these Rules, shall be updated daily in an automated manner.

      7. Sources of formation of data of persons specified in Chapter 2 of these Rules, including foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan, foreigners, and members of their families temporarily staying in the territory of the Republic of Kazakhstan in accordance with the terms of an international treaty ratified The Republic of Kazakhstan unless otherwise provided by laws or international treaties:

      1) information from the information system of the Ministry of Education and Science of the Republic of Kazakhstan (hereinafter referred to as MES RK);

      2) information from the state database of the Ministry of Justice of the Republic of Kazakhstan (hereinafter referred to as the MJ RK);

      3) information from the information system of the Ministry of Labor and Social Protection of the Population of the Republic of Kazakhstan (hereinafter referred to as MLSPP RK);

      4) information from the information system of the Ministry of Healthcare of the Republic of Kazakhstan (hereinafter referred to as the MH RK);

      5) information from the centralized automated database of the Ministry of Internal Affairs of the Republic of Kazakhstan (hereinafter referred to as the MIA RK).

      8. Recordkeeping of consumers in the IS of the Fund shall be carried out automatically based on data received from the State corporation, except for the categories of consumers specified in Chapter 3 of these Rules.

      9. The persons specified in Chapter 2 of these Rules shall be recorded in the IS of the Fund as consumers from the date the relevant category is assigned by the sources of data generation specified in clause 6 of these Rules. If the IS Fund receives information about the exclusion of a person from the categories of persons for whom the state pays, the right to receive medical care in the compulsory health insurance system shall be kept for three months from the date of its exclusion in accordance with paragraph 2 of Article 5 of the Law.

      In case of non-receipt of contributions from the state for the persons specified in paragraph 1 of Article 26 of the Law, the right to receive medical care in the CSHI system shall be kept for no more than three months from the date of termination of payment of contributions in accordance with paragraph 2 of Article 5 of the Law.

      10. The persons specified in paragraph 2 of Article 14 of the Law, except for the persons specified in subparagraphs 1), 10) of paragraph 2 of Article 14 of the Law, shall be recorded in the IS of the Fund as a consumer from the first day of the month if there is information on the payment of deductions and (or) contributions to the IS of the Fund within twelve months preceding the date of payment.

      In case of non-payment of deductions and (or) contributions, the right to receive medical care in the compulsory health insurance system be kept for not more than three months from the date of termination of payment of such deductions and (or) contributions in accordance with paragraph 2 of Article 5 of the Law.

      11. The persons specified in subparagraphs 2), 3) and 4) of paragraph 7 of Article 28 of the Law shall be recorded in the IS of the Fund as a consumer from the date of receipt of information about them.

      12. The persons specified in subparagraph 10) of paragraph 2 of Article 14 of the Law shall be recorded in the IS of the Fund as a consumer from the date of payment of a single aggregate payment and shall be valid until the end of the calendar month, if there are contributions to the Fund for at least three consecutive months preceding the date getting medical assistance.

      13. In the event of technical failures in the operation of the IS of the Fund, the IS of state bodies, the right to receive medical care in the CSHI system of an individual shall be kept until the IS is corrected.

      14. Information about the consumer shall be provided from the IS of the Fund upon request to medical information systems and other information systems to further determine the source of financing for the provision of medical care.

      15. The accounting of consumers who are payers in accordance with Article 14 of the Law in the IS of the Fund shall be carried out automatically with the entry of the following information:

      1) individual identification number of the Consumer;

      2) surname, name, patronymic of the Consumer;

      3) business identification number of the Payer (if any);

      4) name of the Payer;

      5) payment period;

      6) date of receipt of the payment to the Fund;

      7) reference of the payment received by the Fund;

      8) amount of the payment;

      9) payment purpose code.

Chapter 2. The procedure for recordkeeping of consumers belonging to the category of persons, contributions for whom are paid by the state

      16. Contributions of the state for compulsory health insurance are paid for the persons established in paragraph 1 of Article 26 of the Law.

      17. Updating the database of the categories of persons, the contributions for whom are paid by the state, shall be carried out by the State corporation monthly.

      18. To keep records of consumers belonging to the category of persons, contributions for whom are paid by the state, the following information shall be automatically entered in the IS of the Fund:

      1) individual identification number;

      2) the date the category was assigned;

      3) the source of assignment of the category;

      4) the date of exclusion from the category;

      5) source of exclusion from the category;

      6) the reason for exclusion from the category.

      19. Data from the State corporation for accounting and exclusion by categories of persons, contributions for whom are paid by the state, shall enter the IS of the Fund daily.

      20. Recordkeeping of consumers belonging to the category of persons, the contributions for whom are paid by the state, if they have a status for several categories of persons, shall be carried out according to the following priority categories:

      1) children;

      2) persons registered as unemployed;

      3) non-working pregnant women;

      4) a non-working person (one of the child's legal representatives) raising a child (children) until they reach the age of three years, except for the persons provided for in subparagraph 5) of this paragraph;

      5) persons on leave due to pregnancy and childbirth, adoption of a newborn child (children), caring for a child (children) until they reach the age of three years;

      6) non-working persons caring for a disabled child;

      7) non-working person caring for a disabled person of the first group since childhood;

      8) recipients of pension payments, including veterans of the Great Patriotic War;

      9) persons serving a sentence by a court verdict in institutions of the penitentiary (penitentiary) system (except for institutions of minimum security);

      10) persons held in pre-trial detention centers;

      11) non-working oralmans;

      12) mothers with many children, awarded with the pendants "Altyn alka", "Kumis alka" or previously received the title "Mother Heroine", as well as awarded with the orders of "Maternal Glory" of I and II degree;

      13) disabled people;

      14) persons enrolled in full-time education in organizations of secondary, technical and vocational, post-secondary, higher education, as well as postgraduate education;

      15) non-working recipients of state-targeted social assistance.

      Before exclusion from the number of consumers due to retirement from one of the categories of persons specified in part one of this paragraph, a status check shall be carried out for categories of persons lower in priority.

      In case of a positive result of the check, the right to receive medical care in the compulsory health insurance system shall be kept.

Paragraph 1. The procedure for recordkeeping of consumers belonging to the category of "children"

      21. The list of "children" shall be formed by the State corporation based on data from the information system (hereinafter referred to as IS) of the MLSPP RK, obtained from the IS MES RK.

      22. In the IS MES RK, data on children shall be transferred from the state database of individuals of the Ministry of Justice of the RK.

Paragraph 2. The procedure for recordkeeping of consumers belonging to the category of "persons registered as unemployed"

      23. The State corporation shall form the list of “persons registered as unemployed” based on data from the IS MLSPP RK.

      Confirmation of the category shall be carried out by the date of registration and (or) deregistration as unemployed.

Paragraph 3. The procedure for recordkeeping of consumers belonging to the category of "non-working pregnant women"

      24. The State corporation shall form the list of “non-working pregnant women” based on data from the IS MLSPP RK.

      25. In the IS MLSPP RK, data on pregnant women shall be transferred from the IS "Register of pregnant women and women of fertile age" of the Ministry of Healthcare of the RK (hereinafter referred to as IS RPFAW).

      26. After checking the data in the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan for the presence of CPC and (or) CO, the status of non-working pregnant women:

      1) assigned in the absence of payment for CPC and (or) SC for one month preceding the date of reconciliation;

      2) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 4. The procedure for recordkeeping of consumers belonging to the category "non-working person (one of the legal representatives of the child) raising a child (children) until they reach the age of three years"

      27. By the State corporation, the list of “non-working person (one of the legal representatives of the child) raising a child (children) until they reach the age of three” shall be formed based on data from the IS MLSPP RK.

      28. In the IS MLSPP RK, data on persons (both parents) who are married and who have children under three years old with the linking of the individual identification number (hereinafter referred to as IIN) of the parents to each other and the child's IIN shall be transferred from the IS “Registration of civil acts state" MJ RK.

      29. In the IS MLSPP RK, data on the persons established by guardians (trustees) over children under three years old with linking the IIN of guardians and (or) trustees to each other and the IIN of the child shall be transferred from the IS “Republican databank of orphans, children left without parental care" MES RK.

      30. After checking the data in the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan for the presence of CPC and (or) SC in both parents, the category "non-working person (one of the legal representatives of the child) raising a child (children) until they reach the age of three":

      1) assigned to a parent who does not have CPC and (or) CO;

      2) assigned to the mother if both parents do not have a payment for CPC and (or) SC for one month preceding the date of reconciliation in the absence of an application from the father;

      3) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 5. The procedure for recordkeeping of consumers belonging to the category "persons on leave due to pregnancy and childbirth, adoption of a newborn child (children), caring for a child (children) until they reach the age of three years"

      31. The State corporation shall form the list of "persons on leave due to pregnancy and childbirth, adoption of a newborn child (children), caring for a child (children) until they reach the age of three" based on data from IS MLSPP RK.

      32. In the IS MLSPP RK, data on persons on leave due to pregnancy and childbirth based on a certificate of incapacity for work shall be transferred from IS RPFAW.

      33. After checking the data in the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan for the presence of CPC and (or) SC in both married parents, the category “persons on leave due to pregnancy and childbirth, adoption of a newborn child (children), according to caring for a child (children) until they reach the age of three years":

      1) assigned to a parent who does not have CPC and (or) CO;

      2) assigned to the mother if both parents do not have a payment for CPC and (or) SC for one month preceding the date of reconciliation in the absence of an application from the father;

      3) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 6. The procedure for recordkeeping of consumers belonging to the category of "non-working persons caring for a disabled child"

      34. The State corporation shall form the list of “non-working persons caring for a disabled child” based on data from the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan.

      35. After checking the data in the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan for the presence of CPC and (or) SO, the category “non-working persons caring for a disabled child”:

      1) assigned in the absence of payment for CPC and (or) SC for one month preceding the date of reconciliation;

      2) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 7. The procedure for recordkeeping of consumers belonging to the category of "unemployed person caring for a disabled person of the first group from childhood"

      36. State corporation shall form the list of “non-working person caring for a disabled person of the first group since childhood” based on data from the IS MLSPP RK.

      37. After checking the data in the IS of the Ministry of Labor and Social Protection of the Republic of Kazakhstan for the presence of CPC and (or) CO, the category “non-working person caring for a disabled person of the first group since childhood”:

      1) assigned in the absence of payment for CPC and (or) SC for one month preceding the date of reconciliation;

      2) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 8. The procedure for recordkeeping of consumers belonging to the category "recipients of pension payments, including veterans of the Great Patriotic War"

      38. By the State corporation, the list of “recipients of pension payments, including veterans of the Great Patriotic War” shall be formed based on data from the IS MLSPP RK.

Paragraph 9. The procedure for recordkeeping of consumers belonging to the category of "persons serving a sentence by a court sentence in institutions of the penal (penitentiary) system (except for minimum security institutions)"

      39. The State corporation shall form the list of “persons serving sentences under a court sentence in institutions of the penal (penitentiary) system (except for minimum security institutions)” shall be formed based on data from the IS MLSPP RK.

      40. In the IS MLSPP RK, data on persons serving a sentence by a court verdict in institutions of the penal (penitentiary) system (except for institutions of minimum security), except for foreigners or stateless persons temporarily staying in the Republic of Kazakhstan, shall be transferred from a centralized automated base data of the Criminal Executive System of the Ministry of Internal Affairs of the Republic of Kazakhstan (hereinafter referred to as CADB PS).

Paragraph 10. The procedure for recordkeeping of consumers belonging to the category of "persons held in pre-trial detention centers"

      41. The State corporation shall form the list of “persons held in pre-trial detention centers” based on data from the IS MLSPP RK.

      42. In the IS MLSPP RK, data on persons held in pre-trial detention facilities, except for foreigners or stateless persons temporarily staying in the Republic of Kazakhstan shall be transferred from the centralized automated database of the CADB PS.

Paragraph 11. The procedure for recordkeeping of consumers belonging to the category of "non-working oralmans"

      43. The list of "non-working oralmans" shall be formed by the State corporation based on data from the IS MLSPP RK

      44. After checking the data in the IS MLSPP RK for the presence of CPC and (or) SO, the category "non-working oralmans":

      1) assigned in the absence of payment for CPC and (or) SC for one month preceding the date of reconciliation;

      2) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Paragraph 12. The procedure for recordkeeping of consumers belonging to the category of "mothers with many children, awarded with pendants "Altyn alka", "Kumis alka" or previously received the title of "Mother Heroine", as well as awarded the orders of "Maternal Glory" of I and II degree"

      45. By the State corporation, the list of "mothers with many children, awarded with pendants" Altyn alka", "Kumis alka" or previously received the title "Mother Heroine", as well as awarded with the orders "Maternal Glory" of I and II degree" shall be formed based on data from the IS MLSPP RK.

Paragraph 13. The procedure for recordkeeping of consumers belonging to the category of "disabled"

      46. The list of “disabled people” shall be formed by the State corporation based on data from the IS MLSPP RK.

Paragraph 14. The procedure for recordkeeping of consumers belonging to the category "persons studying full-time in organizations of secondary, technical and vocational, post-secondary, higher education, as well as postgraduate education"

      47. By the State corporation the list of "persons studying full-time in organizations, including foreign, secondary, technical and vocational, post-secondary education, higher education, as well as postgraduate education" shall be formed based on data from the IS MLSPP obtained from the IS MES RK.

Paragraph 15. The procedure for recordkeeping of consumers belonging to the category of "non-working recipients of state targeted social assistance"

      48. The list of “non-working recipients of state targeted social assistance” shall be formed by the State corporation based on data from the IS MLSPP RK.

      49. After checking the data in the IS MLSPP RK for the presence of CPC and (or) SO, the category “non-working recipients of state targeted social assistance”:

      1) assigned in the absence of payment for CPC and (or) SC for one month preceding the date of reconciliation;

      2) withdrawn if there are payments for CPC and (or) SC for two months preceding the date of reconciliation.

Chapter 3. The procedure for recordkeeping of consumers belonging to the category of "military personnel, employees of special government agencies, law enforcement officers"

      50. Data on the category "military personnel, employees of special state bodies, law enforcement officers" in the IS of the Fund comes from the Ministries of Defense, Internal Affairs, Emergency Situations, Finance, the National Security Committee, the General Prosecutor's Office, the State Security Service, the Agency of the Republic of Kazakhstan on Counteraction corruption (Anti-Corruption Service) (hereinafter referred to as the Authorized bodies) within the framework of the powers provided, determined by the current legislation of the Republic of Kazakhstan.

      51. The authorized bodies shall transfer information about military personnel, employees of special state bodies, law enforcement agencies to the Fund once every fourteen calendar days.

      52. Recordkeeping of consumers in the IS of the Fund in the category of "military personnel, employees of special state bodies, law enforcement officers" shall be carried out from the moment the information is received from the authorized bodies until the next transfer of information.

      53. The authorized bodies, no later than seven calendar days after changes in the information on the composition of military personnel, employees of law enforcement, special state bodies (admission, dismissal, change in the number of staff), enter information about military personnel, employees of law enforcement, special state bodies to the Fund.

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