The insured can receive up to 2 million MNT in health coverage

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Nearly everyone in Mongolia pays state health insurance fees but most are in the blind when it comes to discounts and benefits they can receive from insurance.

When we get sick, we’re so busy trying to get treated that we forget about the discounts we can receive. Rather being slapped with a huge bill the next time you or your family gets sick, learn about the discounts and benefits you can get through the mandatory health insurance in advance. You don’t have to wait to taste the advantages of being insured – in fact, you can get early diagnostics and screening for free with your health coverage.

In Mongolia, social health insurance is compulsory for all public and private sector employees and low-income and vulnerable population groups. The gover­nment scheme also enables voluntary insurance for unemployed people of working age and foreign nationals. According to the Health Insurance Law, people who pay health insurance can receive healthcare services costing up to two million MNT per year. On top of this, the state is obliged to cover the majority of costs of expensive surgeries, and chemo and radiation therapy.

With the adoption of a new Health Insurance Law in January 29, 2015, the premium rate was raised to fund better quality services and increase benefits. The law provides incentives and discounted prices for 16 types of healthcare services, including ambulatory care, rehabilitative care, some diagnostics tests, medications, and cancer treatment. For instance, a health insurance payer can get up to five million MNT in discounts for a knee replacement surgery, which usually costs seven million MNT. This is a huge benefit for those in need, not to mention it reduces national cash flow spent on health care services abroad.  

Through the ongoing Eleg Buten Mongol National Program, a health insurance payer can get a discount of 210,000 MNT for five types of medications required to treat hepatitis C virus infection, and public and private hospitals provide hepatitis B and C diagnostic tests for discounted rates.

HOW MUCH DO YOU PAY FOR HEALTH INSURANCE?

The government regulates the rate of health insurance premium every year in line with the minimum wage. In other words, the rate varies depending on the minimum wage. The minimum wage has risen to 420,000 MNT in 2020. 

The table below shows the premium rate of health insurance payers.


HEALTH COVERAGE & BENEFITS

According to the law, children and adults can get some health care costs covered with their health insurance. Moreover, a person can who didn’t receive any health care or service using their insurance for three consequent years is eligible for a full health checkup once.

Read the following to know how much discount you can get for certain types of health care services for paying health insurance premiums.

1. Preventive and early diagnostics tests

You can get preventive and early screening worth up to 432,000 MNT a year.

2.    Ambulatory care

Public hospitals contracted with the Social Insurance Office will provide ambulatory care for discounted price.

The insurance will cover 15,000 to 16,200 MNT of one-time ambulance cost.

3.    Diagnostics and lab

Health insurance provides 55,000 MNT per month and 165,000 MNT per season for necessary high-cost diagnostics (computed tomography, MRI, endoscopy etc.). Individual must cover the difference if overall cost exceeds 165,000 MNT a season.

Some hepatitis C screening are available free of charge.

4.    Day care

You can get 110,000 to 300,000 MNT deducted for day care costs at public hospitals. This includes costs of medi­cations and injections, surgery, laser treatments, traditional rehabilitative care, and other services received while getting treated.

5.    Rehabilitative care

You can get 110,000 MNT deducted for Rashaan (spring) nursing/ sanatorium, 116,281 MNT for clinical nursing, and 140,903 MNT for long-term rehabilitation services.

6.    Hospitalization

If you get admitted to a public hospital, you can get a discount of 145,500 to 804,090 MNT depending on the type of disease or illness you have. The discount at private hospitals is lower, ranging between 94,975 to 406,543 MNT.

If you pay health insurance on voluntary basis, you can get 90 percent of your hospital bill covered at provincial/ district-level hospitals and health centers, or 85 percent at state-level hospitals and specialized hospitals. You will be liable to pay only 10 to 15 percent of the full cost.

7.    Traditional Medicine

You can get a discount of 117,000 MNT at public and private traditional medicine clinics.

8.    Pregnancy care

If admitted to hospital, a woman can get health coverage of 145,500 to 804,090 MNT for inpatient services until her 37th week of pregnancy, upon delivery, and up to six weeks after giving birth.

9.    Prescription drug discount

Some drugs can be bought for discounted price with a doctor’s prescription. The list of prescription drugs that can be bought with 20 to 80 percent discounts includes 812 medicines. The discount ranges from 500 to 65,000 MNT.

A doctor’s prescription is valid for a week.

10. Cancer treatment

Depending on health and diagnosis, health insurance covers 450,000 MNT of a one-time chemotherapy treatment. A cancer patient can get 66,000 MNT discount for radiation treatment per day, 175,000 MNT discount for chemotherapy per session.

11. Expensive health care and surgeries

Health insurance will provide coverage for 75 percent of your full cost when it comes to expensive treatments and surgeries. The health insurance fund can provide discounts of 975,000 to 28.74 million MNT for this type of services.

In addition, the Mongolian social health insurance system follows the principle of soli­darity, which means that if you didn’t receive benefits from paying health insurance premium, you can help out a family member instead.

BUDGET FOR DRUG DISCOUNT RAISED

On April 20, the National Health Insurance Council reported that it is providing 20 to 93 percent discounts for over 800 types of medicines through health insurance.

The number of insurance payers getting drug discount has jumped from 380,000 people in 2010 to 1.5 million people in 2020, according to the council. The discount amount also surged from two billion MNT to 40.6 billion MNT in the past decade. While the number of people receiving drug discount increased sevenfold, the financing package increased 20 folds.

A dramatic rise in discounted drug prescription was observed in March and April in connection to the increasing COVID-19 cases in Mongolia. As of the last week of February, 23,300 people got doctor’s prescription, which reached 53,400 people in the last five days of March, the council reported.

As the pandemic spreads further, authorities recently approved a resolution to increase access to drug discounts and remove the lack of insurance funding. Under the resolution, budget for discounted drugs will be increased from April to June, and the financing will be distributed equally to pharmacies operating in provinces and districts.

This is paramount as most pharmacies run out of prescription drugs in the first two to three days of the month and are crowded with huge groups of people during this period. This often leaves people, especially the elderly and people living with disabilities, unable to buy their essential medication for the month.

FAMILY CLINICS HAVE MORE ROLES THAN YOU KNOW

Mongolia shifted to family clinic system in 2002 to improve health care services, speed up primary health care, and increase access to health care. The Law on Health specifies that family clinics should work closest to the public, diagnose and monitor their health, and provide early diagnostics tests and rehabilitation services. However, we waste considerable time and money trying to get proper care at family clinics.

Moreover, family clinics should have sufficient funds as they are financed through the health care fund, health insurance fund, state budget, donations from individuals and organizations, fees, and other legal financial sources. The National Health Insurance Council even raised financing for services covered by health insurance at family clinics at the end of last year.

Senior Communications Specialist of the General Health Instance Office B.Tuvshinjargal said, “By increasing funding to family, soum, and town clinics and health centers, we’re opening opportunities for people to receive diagnostic tests, home care, day care, rehabilitative care and more from these centers. A person should be able to receive day care and relevant medications and injections from a family clinic without paying anything. They can also get blood and urine tests costing less than 20,000 MNT. As long as their health coverage hasn’t been fully used up, they can receive these services as many times as they need.”

Moreover, insurance payers can get tests for syphilis, HIV/ AIDS, influenza, diarrhea, diabetes, helicobacter pylori, breast cancer and sexually transmitted diseases, as well as get cardiogram test and ultrasound scan for free of charge. The standard prices of these services are between 1,100 MNT and 17,100 MNT.

Services provided by family clinics through health insurance


As long as an insurance payer hasn’t used up their annual quota of two million MNT health coverage, he or she can receive these services at family clinics as many times as they need. Instead of paying for these costs, make sure to exercise your rights and receive the benefits that you’re entitled to.

Dulguun Bayarsaikhan

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