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| The national health insurance fund act of 2001 (amended 2003 | Chapter 1
Preliminary provisions
Title and commencement
1. (1) This act may be cited as “the national health insurasnce fund act, 2001”.
Repeal and saving
2. The health insurance public coropoation act, 1994 shall be replaced. Nonetheless, all the regulations made thereunder shall remain in force untile repealed or amended.
Application
3. (1)Subject to the proviosons of section 5 , the provision of this act shall apply to any body employing ten employees or more.
(2)Notwithstanding the provisions of sub –secyion (1) , the employer , who employ less than ten employees may present an application to the executive administration for the acceptance of his subjection to the provision of this act .
Interprations
4. In this act, unless the context otherwise requires:-
“Board”, means the board of directors of the fund, provided for in section 10(1).
“Card”, means the treatment card, issued for the treatment of the patient, and specifies the class, to which he belonges in accordance with the provisions of this act.
“Competent Minster”, means the federal Minster of social welfare and woman and child affairs.
“Director General”, means the fund director general, appointed under the provisions of section 16 (1).
“Director General”, means the fund director general, appointed under the provisions of section 6 (1).
“Employee”, means any male or female employed in return for a wage of whatever nature in the service of an employer and under his supervision and control.
“Employer “, means every natural or corporate person, who employs one employee, or more, for pay, whatever the type may be.
“Executive administration” means the State executive administration of health insurance.
“Family”, means the husband, or wife and those supported thereby, who have no work.
‘Fund, means the National Health Insurance Fund established under the provisions of section 6 (1).
“Health service “means therapeutical medicine services in accordance with the provisions of this act, and the regulations made there under.
“Insured person “, means any person insured in accordance with the provisions of this act,.
“Minister”, means the Federal Minster of Finance and National Economy,.
“Ministry”, means the Federal Ministry of Finance and National Economy,
“Other classes” means the social classes not mentioned in this act and want to be subject to the health insurance..
“Patient”, means an insured person, who is in need of medical care.
“Subscription”, means the monthly subscription, provided for in section 26 (2),
“Wages “, means such basic wages, increments and allowances of periodical nature, as may be paid to the employee.
Insurance compulsory
5.(1)The insurance shall be compulsory, in accordance of the provisions of this act for :-
(a) All employees in the federal Govermnent , the State, organs of local govermnent, public corporations and institutions ,public sector companies,private and mixed sectors and pensioners;
(b) Any other classes, as the Council of Misters may specify, by a decision thereof, on the recommendation of the comptent Minister;
(2) Notwithstanding with provisions in sub–section (1):
(a). Any person not mentioned in sub–section (1) may benefit from The health insurance ; on condition that he shall satisfy the requirments of the provisions of this acts , and the regulations shall specify the manner of his subscreption and the collection of the subscreption thereform ;
(b). the fund shall, in co-ordinations with the social insurance national fund strive that the insurance is to include all sectors;
(3) Notwithstanding with the provision of sub –section (1) the Board may:-
(a) Decide to exempt any body, or class from the compulsory insurance, subject to any conditions as they may deem fit, subject to the particular nature of treatment of the people’s Armed Forces and Police Forces.
(b) Propose specific date, for application of the compulsory insurance, to any class, for approval by the competent Minister, in co-ordination with the bodies concerned.
(4) every employer , to whom the provisions of this act apply , shall present an application for the registration of his name , and the names of his employees , with competent executive administration, within the jurisdiction of which the employer lies , where the minimum number of employees, provided for in section 3 ,is available therewith.
chapter 11
the fund establishment ,quarters and supervision of the fund
6. (1) there shall be established a federal, fund be known as the national health insurance fund and shall have the body Corporate and the right to litigate in its own name.
(2) The headquarter of the fund shall be in khartoum city, and may establish branches inside and out side the Sudan,.
(3) The fund shall directly be responsible , to the competent minster , and he may issue , to the board ,general directions , in any such matter ,relating to the fund , as he may deem to effect the puplic interest , and the board shall act in acordance of such directions .
Vesting of property
7. (1) there shall vest in the Fund:
(a). All the property of the Corporation repealed under the provision in section 2:
(b). All the rights, debts and obligaions relating to the repealed Corporation;
(2). The property , debts aqnd obligations which vest in the fund ,under the provisions of sub –section (1) , shall be assessed , and an amount equal to the netvalue thereof ,shall be entered into the books of the same.
Objects of the fund
8. The fund shall have the following objects:
(a). Manage a federal system of health insurance, in co –ordination with the executive administration , for providing the best medical services to the insured persons and development thereof ,in accordance of the principle of cost sharing.
(b). Lay down the general bases for the manner in lessening the burden of treatment and lessening the finanicel burden of the State in treatment of the insured persons;
(c). Lay down plans and policies of the health insurance for promotion of the medical services, provided to the insured persons and to minimize medical treatment abroad;
(d). Co-ordinate with the executive administrations to rally, train and qualify medical cardes, and lay down the bases of providing suitable atmosphere thereto such as medical work inputs and equipments thereof and provide suitable stability and decent livelihood therefore.
(e) Technically supervise executive administration in the State.
(f). any such other powers, as may be necessary for performance of the functions thereof.
Powers of fund
9. The fund shall have the power to practice all such business, as may enable it to achieve the object thereof, without prejudice to the generality of the foregoing, the fund shall have the following, to:-
(a). Employ such employees ,as it may deem their employment necessary , for shouldering the tasks thereof.
(b). Upon the approval of acompetent Minster, acquire purchase and sell the lands and estates and also construct buildings thereon, maintain the same and erect all the establishments for the achievement of its objects.
(c). Lay down the general safeguards, the investment of its funds, and the funds of health insurance of the states, to benefit of the same , in providing better medical services, in accordance with the regulations made under the provisions of this act .
(d). Require any data, or information , as may relate to health insurance , in the states to, for the purpose of tender of advice ,and help in the application of health insurance in the state .
(f). Co-ordinate between state ,in such matters,asmay relate to health insurance .
(g). any such other powers, asmay be necessary, for carrying out the task thereof.
Establishment and constitution of the board
10.(1) There shall be establised a board for administration of the fund to assume the management of its affaires ,exercise on its behalf ,all the powers here in provided for. It shall be constituted by adecision to be made by the council of ministers, upon the recommendation of the competent minster ,as apart –timer chairman ,from those possessed of experience and competence ,and anumber of members of those possessed of experience and interrest of health insurance and efficiency provided that 50% of the board’s member shall be from the beneficiaries. The director general be a member and reporter
(2) The council of minster shall specify the emoluments and privileges of the chairman of the board.
(3)No combination, of the post of the chairman, of the Board of Directors and the Director General shall be made.
Condition of membership
11. A member of the board shall:
(a). be a Sudanese of good conduct and reputation.
(b). enjoy full capacity.
(c). not have been convicted of an offence involoving honor and honesty.
Remuneration of members
12. There shall be paid to members of the board such remunerations, as may be specifyed by the competent minster, upon the approval of the minster.
Disclosure of interest
13. (1) Every member of the board, who have a direct or indirect interest in any matter, or proposal submitted before the board , for consideration , shall disclose, to the board , the nature of the interest which connects him , to such matter, or proposal .and shall not participate in any deliberation or decision to be passed by the board ,with respect to such matter or proposal .
Meeting of the board
14. (1)The board shall hold and ordinary meeting ,at least once every three months ,upon the call of the chairman thereof ,it may hold an emergent meeting ,where the cgairman deems there is a necessity therefore or upon a request presented by two thirds of the members.
(2)The quorum of the meetings of the board shall be constituted by the attendance of more than half the member.
(3)The decisions of the Board shall be passed by the majority of the members present. And in case of equality of votes, the Chairman shall have a casting vote;
Functions and powers of the Board
15. (1) The Board shall be competent to manage the affaires of the Fund ,administer the business thereof, lay down the general policy, plans and work programs upon which it proceeds, supervise the perfomance and control the business thereof, strive to achieve the objects,and exercise the powers of the same, upon sound bases. Without prejudice to the generality of the foregoing, the Board shall have the following functions ad powers:-
(a). Approve its annual budget and endorse the losses and profits and the final accounts and submit the same to the competent Minister for approval;
(b). Conclude contracts and agreements, on behalf of the fund;
(c). Appoint the occupants of the higher posts of the fund.
(d) Submit periodical reports to the competent minster, on the activieties of the fund every three month.
(e). Propose the terms of service of the employees to the competent minster, who in turn submits the same, after the approval of the minister, to the Council of Ministers for approval.
(f) .Lay dawn the rules and bases, under which the health insurance system is applied, render medical servieces, register the employers and the insured persons, and require the necessary informations.
(g). Recommend, to the council of ministers, to specify the proportions of the contripuotions and subscriptions to be paid by
the employers and the insured persons.
(h). Lay down the organizational chart of the fund and its administrations, and submits the same to the councilof ministers.
(I) .Lay down the bases organizing the financial relations between the fund, the federal organs and exucutive administrations.
(j). Represent the Sudan in the international and regional flora, in the field of health insurance.
(k). Constitute committee or committees from among its members or otherwise to study any subject, and submit the recommendations, with respect thereto, provided that the board shall specify the functions and manner of business of the same.
(l) .Make internal regulations, for organization of the procedure of the meeting thereof.
Appointment and functions of the Director General
16(1) the Director General shall be apointed by adicistion the competent upon the recommendation the board provided that his emoluments shall be specified by the Council of the Ministers.
(2) The director general shall, under the supervision of the board , assume management of the business of the fund , and administer its affaire.he shall be responsible for impleminting the pollicies and the programs , approved by the board .he shall assume the administrative and technical activity of the fund .without prejudice of the generality of the foregoing, the Director General shall have the following functions and powers to :
(a). Supervise the financial ,adminstrative and technical affaires of the fund .
(b). Appoint the excutive directors for the directorates of the fund in the states, medical cadres and employees who are necessary for the performance of the business of the fund, supervise them and follow-up their business and Evaluate the performances thereof in accordance with the regulations.
(c) . Prepare the preposed annual budget of the fund, and submit the same to the board and for approval thereof.
(d). Submit the annual final accounts of the fund to the board, after being audited by the auditor general chamber for approval, provided that it shall be accompanied by detailed particulars of items of assets and liabilities and submit the final accounts of revenues and expenditures.
(e). Follow up the affaires of treatment, protection and medical servises provided to the insured persons in co-ordinations with the states, and submit reports on the same to the board;
(f). submit reports on the performance of the fund every three months.
(G) .Sign contracts and agreements on behalf of the fund.
(h). Any such other functions, or powers, as may be entrusted thereto, by the board.
Chapter 111
Insurance orgnas in the state Health insurance administration in the states
17.(1) There shall be established by the comptent minster an excutive adminstration headed by an excutive director working under the governor of the concerned state and supervised by the competent Minster according to what shall be specified by the regulations.
(2) The excutive adminstration in the states shall bev subject to the control of the state board to be established according to a regulation issued in accordance to the provision of this act determining the manner of its formation ,function and powers within the general policies of the fund ,plan and the approval annual budget.
(3) The excutive director shall asume the excutive, administrative and technical work of the executive administration in the state; he shall submit periodical reports performance of his directorate to the director general.
(4) There shall vest in the fund all the property of the branches corporation in the states and all the rights, debts and liabilities relating to them.
(5). The fund of the subscriptions of insured persons with the executive administration, shall be deemed as public Wagf and mutual support fund and shall not be used, save in rendering the medical services to the insured person.
Chapter 4
Financial provisions
Financial resources of the fund.
18.The financial resources of the fund shall consist of the following:-
(a) Such assets, as may vest therein, in accordance with the provisions of section 7;
(b) Such allocations, as may be appropriated thereto, by the State, as an obligation, in subsidy of health insurance;
(c) Such subscriptions and fees, as may be paid thereto;
(d) The return of investment of its funds;
(e) Such aids donations aids and legacies, as the Board may decide to accept.
Use of the financial resources of the fund
19. (1) the funds of the Fund shall not be used, save for achievement of its objects.
(2) Without affecting the provisions of sub-section (1), the Funds funds shall be used, in the following:-
(a) Management of the Fund and executing its business;
(b) Payment of the Fund’s obligations;
(c) Meeting the expenses of the operating the Fund, including depreciation and renewal;
(d) Payment the salaries, wages, increments, emoluments, of employees, post-service benefits and remunerations of the Chairman and members of the Board.
(3) The Fund, upon the recommendation of the competent Minister, the approval of the Minister, may:-
(a) Keep a separate account, for depreciation and renewal, and the same shall not be disposed of, save for the objects, for which it has been allocated;
(b) Invest the funds, set out in the depreciation and renewal account, in such way, as may achieve the largest possible return;
(c) Strike off the value of the damaged assets, or which have been out of use, by deduction, against the item allocated thereto, in the depreciation and renewal account.
The financial position examined
20. (1) The Fund shall appoint a qualified actuary, to provide actuarial experience, to the Fund, and executive administration, in relation to examining the financial position, periodical and voluntary examination and tendering opinion, about the insurance coverage, and the provided medical services, and any technical, financial consultations, as the work may require.
(2) Where it transpires the existence of a deficit in the funds of the health insurance and the various reserves are not sufficient, to settle the same, the actuary shall explain the reason for such deficit, and the means for securing the evasion thereof, and the Ministry shall be bound to cover such deficit. Where it transpires from the report, the existence of an excess fund, such fund shall be transferred, to a special account, which shall not be disposed of, save upon the proposition of the Board and the approval of the competent Minister.
Classes of insured persons and The proportion of subscription
21. (1) the insured persons shall be divided into classes as follows:-
(a) The employees and there families;
(b) Pensioners and there families;
(c) The poor families;
(d) Families of martyrs;
(e) Self-employed persons;
(f) Other classes.
(2) The proportions of the subscription, for every class of insured persons, shall be specified by a decision of the Council of Ministers, upon the recommendation of the Board, provided that such proportions may be amended, from time to time, by the same way, whenever necessity requires the same.
Deduction of the insured persons’ subscriptions
22. (1) notwithstanding the provisions of any other law, rhe employer shall, upon the request of the competent body, deduct out of the salary of the insured person, the monthly subscriptions, in accordance with the proportions provided for in section 21(2).
(2) The regulations shall specify the manner of payment of the subscriptions, and fees, to be paid by the employers, and other classes.
(3) The subscriptions shall be paid at the end of each month.
(4) The Zakat Chamber, and other organization, which care for the families of martyrs, in co-ordination with the bodies having competence of health insurance, may pay the subscriptions, which have to be paid, in respect of the following two classes:-
(a) Such poor families, as may be specified by the competent bodies, on the basis of poverty line;
(b) Families of martyrs, who have martyred in defending the Country, and leaving their families behind them.
Administrative expenses
23. The administrative and establishment expenses of the executive administrations shall not exceed 10% of the proceeds of its revenues.
Budget of the Fund
24. (1) The Fund shall have and independent budget, to be prepared, as to such general directives, as may be specified by the Ministry, and be submitted, to the competent Minister, for approval of the same.
(2) The Fund shall prepare a development and rehabilitation budget, which shall be discussed, with the competent Minister, and no surpluses, profits, or incentives shall be disposed of, save upon approval of the Minister.
General reserve fund kept
25. The Fund shall keep a general reserve fund, to be fed from time to time, out of the surplus of the resources of the Fund, upon the approval of the Minister, after consultation with the competent Minister.
Record of Assets kept
26. The Fund shall keep a regular record of the fixed and movable assets; such record shall be audited annually.
Keeping accounts books and records and deposit of funds
27. (1) The Fund shall keep accurate and comprehensive accounts of its business, in accordance with sound accountancy bases, and keeps the books and records relating thereto.
(2) The Fund shall deposit the funds thereof, with the banks, in current accounts or investment deposits; provided that dealing in such accounts and withdrawal there from, shall be as to such manner, as may be specified by the board.
(3) The Fund shall notify the Minister, upon opening accounts with banks, in accordance with the provisions of this act; provided that the approval of the Minister shall be obtained, upon opening accounts in foreign exchange.
Auditing
28. The Fund shall keep a regular record of the fixed and movable assets. Such record shall be audited annually.
Final accounts and reports
29. (1) the board shall submit, to the competent Minister, within five months, the following reports:-
(a)a statement of the final account, and the profits and surpluses account;
(b)the report of the Auditor General’s Chambers, on the Fund;
(c)a report setting forth the progress of work in the Fund during such financial year, its future programs and plans, with respect to investment, financing and labour.
(2) The competent Minister shall submit the statements and reports, referred to in sub-section (1), to the Minister, within a period not exceeding the month of June subsequent to the end of the financial year.
(3) The statements and reports shall be discussed, in an annual meeting, during the month of July subsequent to the end of financial year, under the chairmanship of the Minister, and presence of the competent Minister, or whoever he may authorize from the occupants of the higher leadership posts, the Auditor- General and the Director General for:-
(a) Laying down the bases of distributing profits and surpluses;
(b) Approval of the annual report;
(c) Approval of the final accounts and auditing;
(d) Recommending to the Council of Ministers, amendment of remuneration;
(e) Discussion of any such other subjects, as may relate, to the progress of the work of the Fund, with respect to the financial aspects.
Employer’s obligation
30. (1) The abidance, of the employer, by the provisions of any collective agreement, regulations or private scheme, between him and the employees thereof, with respect to the rights of medical care, not specifically provided for in this act, shall continue, as the regulations may specify.
(2) Subject to the provisions of sub-section (1), there shall not be prejudiced, the employee, who enjoys the rights of the private medical care applicable to him, at the date of coming into force of this act, by the following procedure:-
(a) The employer shall calculate the employee‘s subscriptions to the health insurance, in accordance with the provisions of this act, and pay the same to the Fund;
(b) The employer shall have the right to deduct the mount of subscription, set out in paragraph (a), from the entitlements of the employee, granted to him in accordance with the private scheme of medical care applicable to him, and return, the balance of such entitlements, to the employee.
Chapter 5
Medical services for the insured persons
Entitlement to medical services
31. (1) the executive administration shall give due regard to providing the medical and health services, to the insured persons as follows:-
(a) Medical services, at the general practitioner’s level;
(b) Medical services, at the specialist’s level and where required, treatment in hospitals;
(c) Radiography, where required, and laboratory and testing examinations, and otherwise of medical services, and whatever of the same nature.
(d) Dispense the necessary medicines, in all the cases, referred to, in paragraph (a), (b) and (c);
(e) The necessary treatment, and the medical care, necessary during pregnancy and delivery.
(2) The treatment and medical care, provided for in sub-section (1), shall be within the limits of the general policy, to be laid down by the Fund.
(3) The executive administration shall spec ify such safeguards, as under which medical services may be provided, to the insured persons, subject to the provisions of this act.
Medicine services
32. (1) Subject to the general policies, issued by the Board in this respect, the Board shall specify the groups, or classes of medicines, permitted to the dispensed to the insured person.
(2) No person shall endeavor to facilitate obtaining, by the insured person, of medicines, without justification, or not required to be dispensed, by fundamentals of medicine.
(3) No insured person shall dispose of the medicine dispensed to him, to any other person, whether by sale or any other way.
Dentistry services
33. The executive administration shall give due regard to provide dentistry services, to the insured persons, in cases of dental x-rays, extraction and filling of teeth and gum treatment.
The treatment card
34. (1)The fund shall provide the insured person and is family whose number shall be specified by the regulation, with a treatment card according to the form and safeguards stipulated in the regulations. This card shall be national and gives its holder the right to be treated at any health institution providing medical services for health insurance in any state.
(2) Every insured person shall obtain the treatment card from the state excutive administration.
(3) No person shall obtain more than one treatment card.
Insurance of the federal organs’ employees
35. (1) The Fund shall, in co-ordination with the executive administrations, lay down the bases and safeguards, upon which insurance of the employees of the federal government, public corporations and institutions, public sector companies, federal banks and any other federal utilities, shall be made.
(2) The regulations made by the Fund shall specify the procedures, pertaining to insurance of employees of the federal organs.
Chapter 6
General provisions
Proportions of the executive administrations’ contributions to the Fund
36. The Council of Ministers, in consultation with the Board, shall specify a financial proportion, to be levied, upon the executive administrations, for the benefit of the Fund, to eet the expenses of training, scientific research, foreign communications and all other federal matters.
Paying amounts due to the Fund
37.(1) dissolution of an establishment closure because of liquidation or bankruptcy, merger with another firm, transfer by inheritance testament or donation, sale or relinquishment or any other legal procedure which leads to a change in the employer shall not affect the requirment to pay the amount of money due to the fund.
(2) The competent bodies shall require the employer in case of liquidating his enterprise or leaving the country for good to issue a release certificate from the Fund.
(3) The General commercial registrar shall notify the Director General by any legal procedures which lead to a change in the body corporate of the employer or its amendment, by merging its elements or its dissolution.
Administrative and financial sanctions
38. (1) the executive administrations may impose financial and administrative sanctions, upon every employer, who does not pay the subscriptions, provided for by this act, as the regulations made thereby may specify.
(2) There shall vest, in the executive administration, all the amounts, provided for in sub-section (1), and expenditure there from shall be made on such aspects, as for the specifications of which, a decision of the State‘s Board is issued.
39. There shall be deemed to have committed an offence, wherever contravenes the provisions of sections 5, and shall, upon conviction, be punished therefore with imprisonment, for a term, not exceeding three months, or with fine, or with both.
40. (1) The Board, upon the approval of the competent Minister, and subject to the to the provisions of the financial and accounts procedure act 1977, and the regulations, made there under, may make such regulations, as may be necessary, for organizing the progress of the Fund’s work.
(2) Subject to the provisions of section 15 (1) (e), the Board shall make the terms of service of the employees of the Fund regulations.
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