Draft Comprehensive Social Health Insurance Law

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The Universal Periodic Review, Studies

May 31, 2016

"Draft Comprehensive Social Health Insurance Law"

Issued it

Public Policy Analysis and Human Rights Unit

Affiliate Foundation

, Maat for Peace, Development, and Human Rights

Under a project

The Universal Periodic Review as a Tool to Improve Public Policies during the Transition

May 31, 2016

“This release was implemented with the help of the European Union. The content of this publication is the responsibility of the Maat Foundation for Peace, Development and Human Rights and can in no way be considered a reflection of the vision of the European Union.

Decision of the President of the Arab Republic of Egypt

No. () for the year ...

Promulgating the Law on “Comprehensive Social Health Insurance”

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President of the Republic

After reviewing the constitution

And the Penal Code promulgated by Law No. 58 of 1937.

And the Civil and Commercial Procedure Law promulgated by Law No. 77 of 1941.

And the Civil Law promulgated by Law No. 131 of 1948.

And the Criminal Procedure Law promulgated by Law 150 of 1950.

And the Public Authorities Law promulgated by Law No. 61 of 1963.

And Law No. 10 of 1967 in the matter of regulating dealing in medicines of the Public Authority for Health Insurance.

And Law No. 32 of 1975 regarding the system of insurance treatment for government workers, local administration units, public authorities and public institutions.

And the Social Insurance Law promulgated by Law No. 79 of 1975.

And the Social Insurance Law on employers and those similar to them issued by Law No. 108 of 1976.

And the Social Insurance Law for Egyptian Workers Abroad promulgated by Law No. 50 of 1978.

And the Comprehensive Social Insurance System Law promulgated by Law No. 112 of 1980.

And Law No. 99 of 1992 regarding the health insurance system for students.

And the Labor Law promulgated by Law No. 12 of 2003.

And the Social Security Law promulgated by Law No. 137 of 2010.

And Law No. 23 of 2012 regarding the health insurance system for dependent women.

And Law No. 86 of 2012 regarding health insurance for children under school age.

And Law No. 127 of 2014 regarding health insurance for farmers and agricultural workers.

And Presidential Decree No. 1209 of 1964 regarding the establishment of the Public Authority for Health Insurance and its branches for government workers, local administration units, public bodies and public institutions.

It was decided

The following law

(Article 1)

(second subject)

The insured shall continue to benefit from health insurance in accordance with the laws and regulations currently in force, until the date of entry into force of the provisions of the law accompanying them, according to the progression in application, and from this date the following laws referred to them shall be canceled for them:

Law No. 10 of 1967

Law No. 32 of 1975.

Law No. 99 of 1992.

Law No. 23 of 2012.

Law No. 86 of 2012.

Law No. 127 of 2014.

The President of the Republic Decision No. 1209 of 1964 regarding the establishment of the Public Health Insurance Authority shall also be canceled, and its branches for workers in the government, local administration units, public bodies and public institutions shall be canceled, according to the progression in application for the governorates in which the provisions of this accompanying law are applied, until the implementation of the provisions of this accompanying law is completed. The accompanying law throughout the Republic, and that this decision shall be permanently canceled when the provisions of this law cover all governorates of the Republic.

Any provision that contradicts the provisions of the accompanying law in the Social Insurance Law promulgated by Law No. 79 of 1975 or in any other law shall be canceled, and the executive regulations of the accompanying law specify the rules and procedures governing the gradual process of implementing its provisions.

(Article Three)

The Minister in charge of health shall issue the executive regulations of the accompanying law within six months from the date of its publication in the official gazette, and until this regulation is issued, the regulations and decisions existing on the date of its implementation shall continue to work, in a manner that does not contradict its provisions, and in the event of a conflict, he issues temporary ministerial decisions as a transitional phase.

(Fourth Article)

The accompanying law applies to the areas of insurance health services, and does not apply to public and preventive health services, ambulance services, family planning services, and to health services that cover natural disasters and epidemics, and similar services that the rest of the state's agencies are obligated to free of charge.

The Ministry of Health is the health sector regulator and watchdog, and it is responsible for issuing licenses for health facilities.

(Fifth Article)

This law shall be published in the Official Gazette and shall be enforced as of the day following the date of its publication in the Official Gazette, without prejudice to the rules and procedures for progression in the application.

This law shall be sealed with the seal of the state, and shall be enforced as one of its laws.

President of the Republic

Comprehensive Social Health Insurance Law

The first Door

Scope of application of the provisions of the law

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(Art.1)

In implementing the provisions of this law, the following terms shall have the meaning indicated next to each of them:

Commission: Comprehensive Social Health Insurance Authority.
Entities affiliated with the Ministry of Health: They are the other health service providers affiliated with the Ministry of Health other than the General Authority for Health Insurance, and include “the General Authority for Hospitals and Educational Institutes, the Secretariat of Specialized Medical Centers, the Therapeutic Institution in the Different Governorates, Hospitals and Health Units of the Health Directorates in the Governorates.”
The insuredWhoever applies the provisions of this law from the categories referred to in this law according to the progression in the application.
employer: Whoever employs one or more insured workers subject to the provisions of this law.
Family: A group consisting of one or more husband and wife and dependents.
Injured work injury: Whoever sustained a work injury, in accordance with the provisions of the relevant social insurance laws.
Patient: Whoever suffers from an illness or accident other than a work injury.
SubscribeIt is all that the insured receives in monetary compensation from his or her workplace, and in particular the following:
- The wage stipulated in the tables attached to the employment regulations and the bonuses attached to it.
- The wage stipulated in the work contract and the bonuses added to it or the due daily wage.
- Incentives.
- Commissions.
- Allowances, except for the following:
  - Transportation allowance, travel allowance, meal allowance and other allowances paid to the insured in return for the burdens required by his job, with the exception of the representation allowance.
  - Housing allowance, clothing allowance, car allowance and other allowances paid in exchange for benefits in kind.
  - Allowances that are due for the insured to meet the burdens of living outside the country.

It should be noted that the total value of the excluded allowances of 30% shall not exceed the total wage of the insured.

If the insured works for more than one employer, then all the previous elements he receives from each employer shall be considered the contribution wage.

Minimum wage: It is the minimum wage declared by the government at the national level, and a decision on it is issued by the competent minister.
Actuary: A person licensed in the Arab Republic of Egypt to prepare actuarial valuations.
Preventive services: Health services provided to prevent the occurrence of diseases, their complications, and the risk factors that cause them.
Curative services: All types of medical treatment based on scientific evidence, for the treatment of various diseases, whether through medicines or surgical interventions and others.
Rehabilitation services: Services that help the patient to restore his or her functional organic state prior to illness or injury.
Epidemics: Diseases or other health-related events that occur in a specific community or geographical area, at rates clearly higher than what is expected according to previous experience in the same spot and time.
Basic care and family health unitsIt is the first level of facilities providing primary health service, and it provides therapeutic, diagnostic and referral services, reproductive health and first aid for emergencies in some of these units, and that it has the conditions and specifications of quality and is recognized by the Comprehensive Social Health Insurance Authority, and that it is contracted with the Authority And it represents the first point of contact for the beneficiaries of health services, and it has one or more staff to provide the service consisting of an appropriate number of doctors and their assistants, and each unit is concerned with the care of a number of families residing in the geographical area of the unit, to be determined according to the criteria specified in the regulations for this, and the units can provide specialized services According to the availability of specialized doctors, these units provide preventive medicine services in parallel, provided that state agencies bear the cost of those services.
Primary health care and family health centers : It is the second level of facilities providing primary health service, and it provides therapeutic, diagnostic, referral and emergency services to beneficiaries of citizens residing in the geographical area of the center and its units, in addition to providing specialized services according to the availability of specialized doctors, and a maternity home may be available in it, which has the conditions and specifications of quality Recognized by the Comprehensive Social Health Insurance Organization, provided that they are in agreement with the Authority, and the center serves a number of families residing in the geographical scope of the center, which is determined according to the criteria specified in the relevant regulations, and on the other side, these centers are also provided in parallel with preventive medicine services that bear State agencies cost those services.
Hospitals and specialized centers: They are organizations specialized in providing curative and highly specialized health care for the second and third levels, and they are organizations that possess quality conditions and specifications, and contract with the Authority in accordance with the professionally approved insurance referral systems.
Family doctor: He is a doctor who has a specialized or professional academic degree in the field of family medicine, and works at the first level to provide health service, and is responsible for providing an integrated and continuous health service for all groups and ages within the family, and according to his qualifications he can provide basic health service and support lifestyle Health services for all family members, and administrative work within an integrated health team.
General practitionerA physician who is scientifically qualified (holds a Bachelor of Medicine and Surgery), who is restricted and licensed to work as a doctor from the Medical Union, with practical experience, and has the clinical skill necessary to provide basic, integrated and continuous care for all family members in the surrounding community, and to identify, diagnose and treat common and endemic diseases and some emergency cases, He is also fully aware of the foundations and procedures for referring the patient to the various treatment levels, through specific rules for medical practice based on scientific evidence, all in accordance with the standards and requirements specified by the competent authority for the quality of health services.
Those unable (financially): A category of society defined by the Ministry of Social Solidarity, in coordination with the Central Agency for Mobilization and Statistics, and the Ministries of Planning and Finance, according to economic, financial and social criteria, based on the minimum wage standard, inflation rates, and other economic and social standards and studies related to this matter, and they are periodically amended at intervals not More than three years.
Medical and laboratory examinations: All that contributes to determining the diagnosis of the disease outside the clinical examination by the competent doctor, such as laboratory tests, medical imaging, and so on.

(Art.2)

Comprehensive social health insurance is a compulsory system, based on social solidarity, and its umbrella covers all participating citizens within the Arab Republic of Egypt, and the state bears its burdens for those who are unable. The family is the main unit of insurance coverage within the system.

This system is administered through the mechanism of separating funding from service provision, and the authority may not provide or participate in providing treatment services.

Its provisions are gradually applied to the governorates to which decisions are issued by the Prime Minister based on the proposal of the Minister in charge of Health and the Minister in charge of Finance, in a manner that ensures the sustainability of the financial solvency of the system and taking into account its actuarial balance.

(ARTICLE 3)

Comprehensive social health insurance services mean the health services provided to the sick or injured, who subscribe to the system within the Arab Republic of Egypt, whether they are curative or rehabilitative services or medical and laboratory examinations, through the following:

Family practitioner or general practitioner in specified treatment settings.
Specialist physicians, including those related to oral and dental medicine and surgery.
Home medical care when required.
Treatment and stay in a hospital or specialized center, performing surgeries and other types of treatment.
Medical imaging examination, laboratory examinations and other medical examinations and the like.
Rehabilitation services and prosthetic devices according to the basic lists issued by the authority's specialized scientific committees.
Writing prescriptions and dispensing the necessary medicines for treatment, according to the basic and supplementary lists issued by the specialized scientific committees of the authority, as well as making the necessary medical reports.
The primary and periodic medical examination for each job candidate to verify his health and psychological fitness.
A package of insurance services for all diseases, including personal health disasters.

The services provided within the Arab Republic of Egypt shall not be less than the services currently provided to the beneficiaries of the Public Authority for Health Insurance on the day this law was issued.

The Authority may, upon the proposal of the specialized committees, add other services to the aforementioned services, taking into account preserving the financial and actuarial balance of the system.

Treatment abroad for those who cannot be treated through the services provided inside the Arab Republic of Egypt and has treatment abroad, based on a report issued by a specialized committee in this regard, formed with the knowledge of the Comprehensive Social Health Insurance Authority, and the executive regulations clarify its procedures and controls.

The second chapter

System administration

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(ARTICLE 4)

A not-for-profit economic public authority shall be established, which invests its funds for the benefit of the system, called the “Comprehensive Social Health Insurance Authority”. It shall assume the management and financing of the comprehensive social health insurance system, and it shall have legal personality and an independent budget, under the general supervision of the Prime Minister, who issues a decision regarding its regulation and determination. Its specialties.

(Art.5)

The authority shall have a board of directors, whose formation, system of work and the financial treatment of its president and members shall be issued by a decision by the President of the Republic, provided that it includes representatives of the authority, medical unions, representatives of service providers (health care authority - civil society - the private sector), representatives of beneficiaries, and representatives On behalf of the concerned ministries (social solidarity and social insurance funds - the workforce - the interior - the financial - the state council), and the board of directors is the supreme authority concerned with managing the affairs of the authority, and it has the right to take the final decisions it deems necessary to exercise the authority's functions, without the need to approve it on the part Higher management, and in particular the following:

Issuing decisions, internal regulations, and decisions related to the Authority’s financial, administrative and technical affairs.
Issuing regulations related to personnel affairs, in accordance with the regulations governing the Authority.
Approving the Authority’s planning budget, its annual budget and final accounts, and its financial position.
Supervising the work progress of the authority, reviewing and approving its decisions within three months from the date of notification to the Chairman of the Council, otherwise it will be considered effective.
Discussing and approving the actuarial reports of the Authority.
Approving the financial reports and accounts that the Authority is committed to providing, and the actions of the Central Financing Fund.
Express an opinion on the legislation on comprehensive social health insurance.
Expressing opinions on relevant international treaties, agreements or conventions.
Setting financial rules for the disbursement of the funds of the Comprehensive Social Health Insurance Fund in accordance with the policies that achieve the objectives of the Authority, and taking the necessary decisions to achieve the purposes for which it was established.
Review and evaluate the effectiveness of management and performance of comprehensive social health insurance implementation programs.
Approving the price lists of the medical services provided.
Adopting a strategy to bring funds to the authority in order to fulfill its objectives and provide better service
Adopting the system's funds investment strategy.
Study and take decisions in all other matters presented to him by the Executive Management and other bodies.

The council also takes over the other functions mentioned in the decision to establish the authority to achieve its objectives, and the executive regulations of this law determine the rules, procedures and systems for the work of this council, the conditions for the validity of its meeting, and the formation of its technical secretariat, provided that it has a permanent secretariat and a general secretary.

The term of the board of directors is four years, renewable once, and the vice-president of the authority replaces its president in the event of his absence or the presence of an objection to him, and the chairman of the board represents the body before the courts and others, and the headquarters of the authority is in Cairo, and it may establish regional branches in the different geographical regions of the Republic.

(Art.6)

A central financing fund called “Comprehensive Social Health Insurance Fund” shall be established at the Authority and administered by the Authority’s Board of Directors, to finance comprehensive social health insurance services, through the following:

Collecting the financial resources according to what is mentioned in the chapter on financing of this law.
Setting the financial rules for the disbursement of the fund's money in accordance with the policies that achieve the objectives of the Authority, and taking the necessary decisions to achieve the purposes for which it was established.
Internal financial control and full follow-up of all actions.

Fund decisions shall not be effective until approved by the Authority’s Board of Directors.

The authority shall devolve to the authority all the assets, rights and financial obligations of the current General Authority for Health Insurance and replace them in all its legal centers in this regard, and the workers of the current body shall be transferred to the work of the new body in relation to the jobs and businesses related to the scope of its work and enjoy the same conditions and all the benefits that they obtain with retraining and restructuring of workers according to the laws the work.
The current government hospitals may not be closed or sold, and the private sector may not participate in them in any way or privatize them under the pretext that they do not meet quality standards, and the agency responsible for these hospitals and care bodies works to raise their quality to achieve the required quality standards.

(ARTICLE 7)

A public body called the “Health Care Authority” shall be established, to issue a law supplementing this law, and shall have legal personality and an independent budget, and include all service delivery outlets affiliated with (the current Public Health Insurance Authority, the Ministry of Health, the treatment institution, the Teaching Hospitals Authority, and the specialized medical centers. University hospitals, and other government hospitals), and this is done gradually after rehabilitating them in accordance with quality and accreditation standards, and the inclusion decision is issued by the minister in charge of health, and it remains subordinate to the state.

The Authority is the main tool of the state in controlling and regulating the provision of insurance health services.

Any other “non-governmental” hospitals may be included, in accordance with the same specific standards for quality and accreditation, and standards set by the Health Care Authority as detailed in the supplementary law.

The state shall gradually raise the quality and efficiency of its health facilities, before starting to implement the system in the governorate in which it is scheduled to start until it obtains accreditation.

(Art.8)

The authority has the right to follow up on the subscriber in any of the health service providers, and it also has the right to exclude the service provider from the records of its qualified service providers, in the event that it is proven his default or breach of the agreed level of medical care in accordance with Article (8) of this law, and the authority shall be responsible For the continuation of the treatment of the injured person or the joint until he recovers or is proven unable to.

The insured has the right to choose treatment destinations from among the parties contracting with the authority, to provide the service according to the referral levels specified in the law, its executive regulations, and the geographical scope.

In the event that the insured turns to a treatment agency that is not contracted with the authority, the executive regulations shall regulate the controls for reimbursement of expenses according to the agency’s prices.

(ARTICLE 10)

The Health Care Authority undertakes a primary medical examination for each job candidate, to verify his health and psychological fitness to carry out this work, before taking up the job, and the nature of work and the type of disease the candidate is exposed to for work are taken into account in conducting the medical examination.

The Health Care Authority also examines the insured persons exposed to contracting one of the aforementioned diseases periodically, as stipulated in the executive regulations, and it is the body responsible for identifying those exposed to an occupational disease, in return for the fee determined by the Authority for each insured that it examines, and the employer bears The value of this fee, and he shall pay it to the Authority within ten days from the date of its claim.

The Authority shall also issue certificates of disability resulting from infection with an organic disease and its percentage, as well as certificates of disability resulting from an occupational disease or other work-related injury and its percentage.

The Comprehensive Social Health Insurance Authority is obligated to notify the injured of the end of treatment, and of the disability and percentage of disability that he may have left, and the injured or sick person has the right to complain about the determination of the end of treatment or the failure of the disability before the medical arbitration committees stipulated in the social insurance laws.

The authority is also committed to the notification referred to in the previous paragraph for both the employer and the National Authority for Social Insurance, indicating the days of delay in treatment, if any, all in accordance with the terms and conditions for which a decision is issued by the minister in charge of health in agreement with the minister in charge of insurance.

Business entities are obligated to inform the Authority of the occurrence of the injury immediately after it occurs, according to the procedures and timings and using the forms approved by the Minister in charge of Social Security in agreement with the Minister in charge of health.

The termination of the injured person's service for any reason does not prevent his further treatment of his injury.

If the period of secondment, assignment, or leave to work abroad has expired, and the injured person is still in need of treatment, the employer must refer him to the designated treatment agency to complete his treatment.

(Art.11)

An independent national body, called the “Egyptian Authority for Quality and Accreditation,” shall be established to set quality standards, monitor and approve their application to health care facilities, and a law shall be issued in this regard that complements this law, defining its terms of reference and its work system, and has legal personality and an independent budget.

Chapter Three

Financing

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(Art.12)

The comprehensive social health insurance system shall be financed from the following:

First: Established government spending for healthA percentage of not less than 3% of the gross national product, gradually increasing until it is in line with global averages.

Second: The share of the insured and dependents:

The contributions that the insured who are subject to this insurance pay for themselves, in accordance with the percentages mentioned in the attached Schedule No. (1).

In the event that more than one attribute is combined, the insured shall be obligated to value the contributions for all the income obtained.

The contributions that the head of the family is obligated to pay on behalf of his wife who is not working and does not have a fixed income, and all of the children and dependents who live in his support according to the accompanying Table No. (1), and the subscription for children and dependents continues until they join a job or marriage or they reach adulthood, and then the state assumes payment Insurance for them until they join work.

Third: The share of business owners:

Business owners defined by social insurance laws are obligated to pay their share of their employees' contributions at the rate of 3% per month from the subscription wage of the insured worker, in accordance with the provisions of the aforementioned Comprehensive Social Health Insurance Law for sickness insurance and treatment services, other than the contribution for work injury according to attached Table (2) .

Fourth: Fees and Contributions: Performed by the insured upon receiving the service outside the hospital stay, in accordance with the attached Schedule (3).

Exempt from paying the contributions of those who are unable to pay the value of their contributions from the public treasury, as well as pensioners, pensioners and those with chronic diseases, according to the determination issued by the minister in charge of health, and in the event of entering hospitals, the insured does not bear any contributions, including the tests that are conducted in preparation for admission to hospitals or To perform surgical operations.

Fifth: The return on investment of the Authority’s funds.

The investment of these funds is managed according to an investment strategy, the rules of which are defined by the executive regulations, and the President of the Republic may delegate any of the heads of the health authorities' boards mentioned in this law to establish companies in accordance with the provisions of the law on joint stock companies (working in the field of health services only) with the aim of raising the quality of health services provided And the development of performance and raising the efficiency of the system employees.

Sixth: Public treasury share for those who are unable:

The contribution value of the insured persons from the categories of those who are unable to pay is 4% of the minimum wage per month for the breadwinner, 2 % for the non-working wife without fixed income, and 0.51 TP1T of the minimum wage per month for each child and dependent.
The value of the contributions required upon receiving the service for those exempted.
3% percentage of the monthly pension value of pensioners (or the National Authority for Social Insurance is obligated to pay it).

Seventh: other sources of income:

The following sums will be collected as apportionment taxes in accordance with this law:

Health taxes:

90% percentage of the proceeds of fines and confiscated money sentenced for health-related crimes, as stated in the Penal Code.
10% percentage of the outcome of hospital health services improvement offices.
Subsidies, donations and grants provided to the Comprehensive Social Health Insurance Organization.
An amount ranging between 500 - 1000 pounds when extracting or renewing licenses for treatment centers, medical clinics, hospitals and pharmacies (according to the type and size of the institution).

Taxes for products Pollutants of the environment and affecting health:

15% of the value of each pack of cigarettes sold in the local market, whether domestic or foreign production.
15% of the value per unit sold of non-cigarette tobacco products.
15% of the value per unit sold of liquor.
5% of the value of every ton of cement or ton of iron manufactured, sold in the local market, whether it is domestic or foreign production.
3% yields per kilogram value of agricultural chemicals or pesticides sold.
Forgetting 7% from the fines collected by the government such as (traffic fines - electricity - water - building violations - trespassing on agricultural lands)
2% from every minute of the current mobile networks or any other networks
5 % from state land auctions
1% is a private sector and investment company that is exempt from 7% for social responsibility.
1% is from the annual proceeds of private funds.

Other taxes:

5% proceeds from the total revenue of gambling and racing clubs.
3% proceeds from the sale of tickets to entertainment houses.
A fee for each tourist night of two US dollars, borne by the tourist.
5% proceeds from the value of the tax on possession or ownership of agricultural lands of more than five acres.
5% proceeds from the value of the community real estate tax.
An additional 2% rate shall be applied to any additional sales tax that may be imposed in the future.
10% when obtaining a driver's license for the first time and renewing it every time.
10% when issuing or annual renewing a license to operate cars with a capacity of more than 1000 cc.
20% toll from the toll value collected for each vehicle's traffic on highways that are subject to the toll collection system.

He shall pay the following amounts stated and on the dates specified against each of them:

First: Insured persons subject to social insurance laws and pensioners:

The employer is obligated to pay the contributions due on him monthly to the authority, and it includes: the share that he is committed to, and the share that he is obligated to deduct from the wage of the insured to pay the contributions due on him and his dependents, provided that they are supplied on the same dates of payment of social insurance contributions.
The National Authority for Social Insurance shall deduct the value of the comprehensive social health insurance contribution from the pensioner and the beneficiaries upon entitlement to the monthly pension, and to pay the contributions monthly to the Comprehensive Social Health Insurance Authority.
The National Social Insurance Organization is obligated to collect the health insurance contributions due from the various bodies subject to the social insurance laws, along with the social insurance contributions.
The Ministry of Social Solidarity shall supply the subscriptions of those who are unable to be covered by a social insurance umbrella and who benefit from the monthly benefits under its various names.

Second: Insured persons who are not subject to social insurance laws:

Self-employed workers, professionals and craftsmen without regular salaries, and the head of the family who is not subject to the laws of social insurance, are obligated to pay his contribution and that of the wife who is not working or has no fixed income, and whoever lives under his care from among the children and dependents, in 4 annual payments to the Comprehensive Social Health Insurance Authority, And in the event of the death of the head of the family, the owner of the guardianship is obligated to pay the contributions from the funds of the young unless he falls within the categories that are unable to.
Agricultural associations are obligated to collect the contributions of comprehensive social health insurance for the insured working in agriculture, as well as the wife who is not working or has no fixed income, and the children and dependents who live under them, in four annual payments, and supplies them to the Comprehensive Social Health Insurance Authority.
The authority may undertake to collect these amounts to any governmental, non-governmental or private entities that have collection mechanisms, such as: the National Authority for Social Insurance, the tax authority, companies, collection representatives, or others.

Evidence of continued payment of the comprehensive social health insurance contribution is considered one of the main justifications for all stages of governmental, private and private school enrollment, and the renewal of work permits, professional licenses, driving licenses and the like, in accordance with the details contained in the executive regulations.

(Art.14)

In the event that an obligee to pay subscriptions delays the payment of contributions on the specified dates, he is obligated to pay an additional annual amount for the delay period from the due date of payment until the end of the month of payment, and the additional amount is calculated at a percentage equal to the discount rate announced by the central bank in the month in which the sums must be paid in addition to 2%.

(Art.15)

The bodies stipulated in Article (13) of this Law are obligated to supply the subscriptions of the insured and the business owners referred to in Article (12) to the Comprehensive Social Health Insurance Authority within 30 days of their collection, after deducting a percentage agreed upon with those authorities, within the limits of A maximum of 0.5% of what was collected as an incentive for workers in the bodies that collect contributions, as detailed in the executive regulations, and this incentive is not included in the health insurance contribution wage.

(Art.16)

The authority has the right to use the necessary means to collect contributions and other financial dues, and other rights stipulated in this law, and all banks in the Arab Republic of Egypt, the General Authority of Nasser Social Bank, the Postal Authority, the General Authority for the Development and Agricultural Credit Bank, the banks affiliated to it, and other bodies, By collecting and paying any dues that the authority assigns to it, in accordance with protocols or agreements that the authority concludes with those authorities, and the executive regulations of this law determine the rules governing these matters.

(Art.17)

The financial position of the comprehensive social health insurance system is examined actuarially at least once every three years by one or more expert actuaries specializing in the health field, to be assigned by a decision of the Prime Minister, based on a nomination from the Minister in charge of Finance, the Minister in charge of Health and the Chairman of the Committee Health in Parliament, and in the case of an actuarial surplus, reserves are created, and in the event of a deficit, the actuary shows its causes and the method for avoiding it, and the presentation is made to the House of Representatives to consider adjusting the value of contributions, contributions and other funding sources.

(Art.18)

The Authority may deposit its funds in a special account within the consolidated treasury account, and an annual return is due on it equal to the average return on government securities, and the disbursement from it is only with the approval of its board of directors.

The Authority’s funds shall be private funds that enjoy all the aspects and forms of protection established for public funds, and their returns are the right of the beneficiaries of them. They are invested in a safe investment for the benefit of the system, in accordance with the provisions of this law and its implementing regulations.

Chapter IV

General Provisions

———–

(Art.19)

All competent authorities are obligated to provide the Authority with the necessary data about those subject to the provisions of this law, their geographical distribution, their ages and occupations, and all information that the Authority requires regarding the conduct of its activities.

(Art.20)

In order to benefit from the comprehensive social health insurance services, the beneficiary must be a subscriber in the system and pay the contributions, and in the event of non-subscription or defaulting of payment, he or whoever is under his care will be treated and punished with a fine for each year of delay equal to one quarter of the annual subscription value, and in the event of failure to pay Punished according to what the authority deems fit, starting from the date on which the provisions of this law come into effect within the governorate to which the patient belongs, and this condition does not apply to insured persons working in the state’s administrative apparatus, local administration units, public bodies, workers in the public sector, the public business sector, pensioners, and the private sector subject to the provisions Social insurance laws, in the event that the employer fails to supply contributions to the Authority.

(Art.21)

The Comprehensive Social Health Insurance Authority shall establish a database for the beneficiaries of the system, which includes all the data necessary for its implementation of the provisions of this law, and it shall be linked to the databases of the National Authority for Social Insurance, the Civil Status Authority and other relevant authorities related to the application of the provisions of this law, and all concerned parties shall implement the provisions of this law. The provisions of this law, whether governmental, non-governmental, or for providing the authority with all necessary data and information and updating them periodically, and making its information networks available to the Comprehensive Social Health Insurance Authority, within the scope of application of the provisions of this law.

(Art.22)

The insured bears his share and the employer's share for the periods of internal or external secondments, and special or study leave, for which no wages are paid, and he directly transfers them to the Comprehensive Social Health Insurance Authority, except for:

Vacations for childcare in accordance with the provisions of the Child Law.
Scholarships, study leave, and scientific tasks granted in accordance with the provisions of Law No. 112 of 1959 for the Organization of Scholarships and Academic Leaves Affairs, or Universities Law No. 49 of 1972, so the sending body, the delegate or the student shall bear the share of the worker and the employer, as the case may be.
Secondments to the units of the state's administrative apparatus The borrowing party bears the employer's share.

(Art.23)

The facility shall guarantee, with all its material and moral elements in any hand, the full entitlements of the Authority, and the successor to whom the ownership of the facility has devolved for any reason whatsoever shall be responsible for fulfilling all the obligations owed to it by the Authority, in accordance with the Civil Law, within the limits of the value of what was transferred to him.

(Art.24)

All fixed and movable funds of the Authority and the fund affiliated to it, and all its investment operations and returns of whatever type, are exempt from all taxes and fees, including the general tax on sales, and the operations carried out by the Authority are also exempt from being subject to the provisions of the laws related to the supervision and control of insurance bodies and companies.

(Art.25)

Without prejudice to the reasons for severing the statute of limitations stipulated in the civil law, the statute of limitations period shall also be interrupted by warning the employer to pay the sums due to the authority under this law, by virtue of a registered letter accompanied by acknowledgment of receipt that includes a statement of the value of these amounts. The work that has not previously subscribed to the comprehensive social health insurance for all or some of its workers, except from the date of the Commission’s knowledge of their enrollment with it, and the statute of limitations shall not apply to the Authority for the insured who has not previously participated in the comprehensive social health insurance except from the date the Commission is aware of the availability of conditions Subject to the provisions of this law.

(Art.26)

The capacity of the judicial seizure is established for the authority’s employees whose jobs are determined by a decision from the Minister of Justice after coordination with the Commission’s president, in order to control the crimes stipulated in Chapter Five of this Law.

For this purpose, they may enter and inspect the places of service provision and examine the equipment, devices, medicines, or other medical or therapeutic supplies, as well as view the records, books, documents and all the papers that are required for the implementation of this law, as detailed in the executive regulations.

(Art.27)

Lawsuits related to the implementation of the provisions of this law that are filed by the Authority or the insured are exempt from judicial fees in all degrees of litigation, and the competent court may include the ruling in these cases with expedited enforcement and without bail.

(Art.28)

The sums owed to the Authority under the provisions of this law shall have a privilege - before taxes and customs - over all the debtor’s funds, including movable and real estate - and these sums are collected before judicial expenditures, and the authority has the authority to collect them through administrative seizure, and these dues may not be forfeited by prescription.

(Art.29)

The Comprehensive Social Health Insurance Authority may provide its services to citizens of foreign countries residing or coming to the Arab Republic of Egypt, and the Authority may lay down regulations and requirements for foreign citizens in accordance with the health services provided to Egyptian citizens in different countries whenever possible.

Chapter Five

Penalties

————

Without prejudice to any more severe penalty stipulated in any other law

(Art.30)

A penalty of imprisonment for a period not exceeding three months and a fine of not less than two thousand pounds and not exceeding ten thousand pounds, or one of these two penalties, shall be inflicted on whoever gives incorrect data or refuses to give the data stipulated in this law or in the regulations or decisions implementing it if they result from That obtaining money from the authority is unlawful.

The same penalty shall be imposed on anyone who prevents the Authority’s employees who have the status of a judicial seizure from entering the workplace, or who fails to view the records, books, documents and papers required for the implementation of this law, or who intentionally - by giving false information - fails to fulfill the authority’s dues.

(Art.31)

A penalty of imprisonment for a period not exceeding six months or a fine of not less than fifty thousand pounds and not exceeding seventy five thousand pounds, or either of these two penalties, every worker in the authority or one of the doctors, pharmacists or others contracted with it facilitates the participant or others whom the authority provides medical care to Unlawfully obtaining medicines, services or prosthetic devices, or the medical assets do not require disbursement to him, according to what the specialized committees see in this based on medical protocols.

The same penalty shall be inflicted on whoever was dispensed with medicines or prosthetic devices and then disposed of them to another in return, as well as the one disposed to him and anyone who intermediates in this, if he knows that they have been disbursed based on the comprehensive social health insurance system, and the confiscation is made by a court ruling.

In all cases, the court decides to confiscate medicines or prosthetic devices in favor of the Comprehensive Social Health Insurance Organization.

(Art.32)

A penalty of imprisonment for a period of no less than a year and a fine of not less than one hundred thousand pounds and not exceeding two hundred thousand pounds, or one of these two penalties, shall be imposed on any provider of health care services, beneficiaries, or workers in the Authority, who intentionally submits false claims or claims for services that have not been provided, Or allowed non-subscribers to the system to obtain services unlawfully.

(Art.33)

A penalty of imprisonment for a period not exceeding six months and a fine of not less than one hundred thousand pounds and not exceeding two hundred thousand pounds, or either of these two penalties, shall be inflicted on every employee of the authority or service providers who helped the employer or subscriber to evade fulfilling his obligations stipulated in this law.

(Art 34)

A fine of not less than twenty thousand pounds and not exceeding fifty thousand pounds, or one of these two penalties, shall be imposed on the official or employee in charge of the authorities stipulated in Articles (13) and (22) of this law, who does not supply the subscriptions of the insured and the business owners referred to. To it in Article (12) of the Comprehensive Social Health Insurance Authority within 30 days of its collection.

(Art.35)

A penalty of imprisonment for a period not exceeding one year and a fine of not less than five thousand pounds and not exceeding fifty thousand pounds, or one of these two penalties, the competent employee in the public authorities or the public sector and the public business sector or the business owner from the private sector, and the person responsible for him who does not participate in the authority For any of the employees affiliated to his entity subject to the provisions of this law, or who did not participate with their real wages.

(Art.36)

The same penalty shall be imposed on the employee in the public sector, in the public sector and in the public business sector, or in the private sector, or by the official who bears the insured for any share of the comprehensive social health insurance expenses that are not stipulated in this law, and the court on its own initiative obliges him to The insured will be refunded the value of these expenses incurred by them.

In all cases, the fine will multiply according to the number of workers for whom the violation occurred.

(Art.37)

A penalty of imprisonment for a period not exceeding one year or a fine of not less than twenty thousand Egyptian pounds and not more than fifty thousand Egyptian pounds, or one of these two penalties shall be inflicted on whoever fails or neglects to perform a course in providing health services to the insured that leads to the occurrence of disability or death. From the Medical Council.

(Art.38)

Every private institution that indulged, failed, or refused to receive any patient or injured, is punished by stopping activity for a period not exceeding one year, with a fine of not less than 50 thousand Egyptian pounds (with the institution's work permit canceled in the event of a recurrence of the mistake, and a committee formed by the Syndicate Council shall decide on the incident. the doctors.

(Art.39)

All sums judged for crimes stipulated in this law shall be transferred to the Comprehensive Social Health Insurance Organization.

Table No. (1) Contributions of the insured and dependents

Category	Subscription	Dependents
Insured workers subject to Social Insurance Law No. 79 of 1975.	1% of subscription fee.	2% for a wife who is not working or has no fixed income, 0.5% for each son or dependent.
Owners of commercial, industrial and professional activity, owners of real estate wealth and owners of agricultural lands.	4% of net income according to the tax return initially, then according to the conclusion of the tax authority.
Partners in limited liability companies.
Shareholders in dividends of joint stock companies and companies limited by shares.	4% of the value of profits according to a certificate approved by the Financial Supervision Authority.
Egyptians working abroad are not subject to Article (22) of this law.	4% of net income according to a certificate approved by the Egyptian Embassy.
People whose income is more than the minimum wage is unknown, according to the results of social research from the Ministry of Social Solidarity.	4% of minimum wage.
Those entitled to a pension.	2% of the monthly pension amount.
Pensioners.	1% of the monthly pension amount.
Those who are unable (those entitled to various benefits)	4% of the minimum wage	It is borne by the state treasury

Table No. (2) The share of business owners (of their employees)(

The price of registration

3% for sickness insurance and treatment services from the total contribution wage for insured workers in accordance with the provisions of Law 79 of 1975 per month, in addition to the rates specified in social insurance laws that are designated for the treatment of work injuries.

Table No. (3) Fees and Contributions of the Insured (Non-Hospital Residents)

Contribution value *	Medical service
30 pounds.	Home visit.
20 % of total value up to a maximum of 50 pounds.	Medicine.
10% of the value up to a maximum of 100 pounds.	Radiology and all types of medical imaging.
5% of value is a maximum of 50 pounds.	Medical and laboratory analyzes.