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Territorial Health Insurance Funds

Purpose and functions of the THIF

11. The purpose of the THIF is to guarantee, through the disposal of the part of the budget of the Compulsory Health Insurance Fund transferred to it by the National Health Insurance Fund, the provision of health care services to persons with compulsory health insurance (hereinafter - insured), the cost of purchasing medicines and medical aids, reimbursement of the costs of the purchase of prostheses of limbs, joints and organs and the cost of prosthetics services, the costs of services provided and the purchase of medicines and medical aids issued, as well as the compensation of rental of medical equipment necessary for insured persons to receive home care.

12. In order to achieve its operational goal, the THIF performs the following functions:

12.1. According to the order established in the Civil Code and the Ministry of Health, concludes contracts with health care institutions, pharmacies and health insurance and entities, mentioned in article 262 of the Law, at the authorization of the National Health Insurance Fund with entities mentioned in article 262 of the Law,  compensate in due time and per order specified in such contracts the costs for health care services provided to the people insured by the compulsory health insurance (hereinafter - insured), as well as the costs of issued medicines and medical assistance measures, as well as costs of rental for medical measures, which are needed to ensure the patient's healthcare at home.

12.2. In accordance with the procedure established by the Law on Health Insurance, reimburse the insured for the costs of purchasing medicines and medical aids, the costs of medical rehabilitation and sanatorium treatment, the costs of acquiring prostheses of limbs, joints and organs and the costs of prosthetics services;

12.3. maintains the Register of Persons insured with compulsory health insurance;

12.4. finances municipal health programs;

12.5. analyses and evaluates data on the health status of the population of county municipalities and trends in the demographic structure of the population;

12.6. controls the quantity, quality and compliance of personal health care services paid for from the budget of the Compulsory Health Insurance Fund in its area of activity, the legality of prescribing and dispensing medicines and medical aids, as well as the issues related to the provision of these services, the activities of health care institutions, pharmacies and economic entities referred to in Article 26 2 of the Law on Health Insurance;

12.7. informs the institution, its founder, the National Health Insurance Fund, and, if necessary, other institutions about the violations established during the control, demand liability and elimination of the violations from the offender;

12.8. checks whether the accounts of health care institutions, pharmacies and economic operators referred to in Article 26 2 of the Law on Health Insurance, and, if authorized by the National  Health Insurance Fund , the undertakings referred to in Article 26 1 of the Health Insurance Fund, as well as related accounting and other documents related to it;

12.9. Controls the availability and adequacy of personal health care services provided to the insured in accordance with the procedure and conditions established by the Ministry of Health;

12.10. in accordance with the Civil Code and other legal acts and agreements, recovers damages caused to the Compulsory Health Insurance Fund from health care institutions, pharmacies, economic entities referred to in Article 26 2 of the Law on Health Insurance, and when authorized by the National Health Insurance Fund recovers from undertakings referred to in Article 26 1 of the Law on Health Insurance and imposes penalties;

12.11. performs financial and economic analysis of the trends in the use of budget funds of the Compulsory Health Insurance Fund and the structure, availability and quality of health care services in its area of activity;

12.12. publishes information on its activities, notifies the insured about the provided personal health care services, the procedure and conditions for the provision thereof;

12.13. protects rights and legitimate interests in courts and other state institutions in accordance with the procedure established by legal acts;

12.14. perform functions and one-time assignments not provided for in these Regulations, but assigned by the National Health Insurance Fund;

12.15. performs other functions established by laws, these regulations and other legal acts.
Source of information: 30 April 2021 Director of the National Health Insurance Fund under the Ministry of Health Order no. 1K-141 “On Approval of the Regulations of Territorial Health Insurance Funds”.

Last updated: 07-06-2021