Health Payment Center

The regulation Nr. 1046 issued by the Cabinet of Ministers on 19 December, 2006 “Health Care Organization and Financing Procedures” stipulates that the following:

SERVICES ARE NOT PAID FROM THE STATE BUDGETARY FUNDS

1. Health care services, provided that the patient does not have the referral issued by either his or her family doctor or other medical specialist, who, in turn, do not have contractual relations or they have not entered into agreement with Health Payment Center. Without a referral issued by a family doctor or other medical specialist one can receive emergency medical care or a consultation provided by medical specialists who are in direct availability, the latter being paid from the state budgetary funds (with the lists of medical specialists who are in direct availability you can acquaint yourself here).

2. Orthodontic treatment (excluding the very first consultation provided to children under the age of 18 and the persons under the age of 22 with inborn face-jaw clefts), for implementation of sealants, for dentistry care provided to persons over the age of 18, as well as for teeth prosthetics (for those persons who got injured in the liquidation process of the consequences of Chernobyl nuclear accident and also for persons who got injured as a result of Chernobyl nuclear accident itself in accordance with the regulations in paragraph 14 of social protection law certain persons may receive dentistry care in the amount of 50 %, but the expenses for teeth prosthetics with removable plastic dentures – in full amount);

3. Execution of injections in ambulatory care in the skin, subcutaneous tissue, intramuscularly and intravenously (except for the cases if the emergency medical care or health care in a day patient facility and medical treatment is provided to oncological patients, patients with diabetes mellitus, patients with mental illnesses, children under the age of 18, patients who suffer from tuberculosis, pregnant women and women in their post-labour period till 42 days, patients who suffer from haemophilia, patients with pernicious anaemia, patients who receive home care, as well as patients who receive sustained artificial pulmonary ventilation at home);

4. Primary medical precautionary measures, which are required when starting on a job, as well as compulsory health check-ups, provided that the factors of one’s work environment have been changed;

5. Recurrent medical examinations and check-ups, which are required due to work conditions or specific character of the work;

6. Legal abortions (except for abortions carried out due to medical indications);

7. Maintanance of both cell bank and sperm donor bank, artificial insemination, as well as in vitro fertilization;

8. Same or informatively equivalent examinations in hospital, which are repeatedly carried out in the course of one month starting from the day when the examination with the referral or recommendation from a family doctor is carried out (except for the cases if the patient receives emergency medical care);

9. Sexological medical treatment and sex change;

10. Provision of medical care in public events;

11. Cosmetological services and esthetic surgical operations;

12. Homeopathic treatment;

13. Prescription and delivery of optic goods for correction of acuity of vision, except for lenses and rims for glasses and contact lenses for those children who have been diagnosed with high degree myopia (above 5,0 Dsph), high degree hypermetropia (above 4,0 Dsph), high degree astigmatism (above 1,0 D), high degree anisometropia (above 2,0 D), aphakia in case of inborn cataract or aphakia acquired to one or both eyes, acquired shortsightedness above 7,0 Dsph, keratoconus, accommodative strabismus, paresis – bifocals glasses, albinism, inborn retinal dystrophy with photophobia confirmed by objective examination methods - photochromic lenses, corneal scarring, opacities – cosmetic contact lenses prosthetics, III-IV degree blindness not depending on the degree of refraction anomaly;

14. Purchase of a hearing aid (except for hearing implants for children);

15. Psychotherapeutic and psychological care (except for care provided in the departments of psychiatric profile or in certain specialized hospitals, in rehabilitation programmes for persons getting medical treatment from alcohol or drug addiction, as well as in provision and maintenance of ambulatory palliative care for children);

16. Vaccination (except for passive immunotherapy, as well as vaccinations specially determined in the vaccination calendar, vaccination against influenza in accordance with the normative acts concerning the procedure for compensation of the expenses for the delivery of medication and medical equipment meant for ambulatory medical treatment);

17. Precautionary and other medical examinations and check-ups (except for the precautionary examinations and check-ups mentioned in Annex 5 to the regulations of “Health Care Organization and Finansing Procedure”);

18. Determining and evaluating the impact of alcohol, narcotic, psychotropic and toxic substances (except for the cases if the latter is necessary for provision and maintenance of a certain medical process);

19. Stationary medical treatment of those patients, the diseases or traumas of which can be treated in ambulatory care;

20. Health care services provided by medical specialists and stationary medical institutions, if the patient refuse, in written form, from waiting for certain planned type health care services, and himself or herself or also by means of some third person carries out all payments for the corresponding health care services;

21. Medical treatment which suggests implementation of non-traditional medicine methods;

22. Transplantation of organs and tissues (except for blood and its medications, kidneys, autologic peripheral blood and allogeneic blood stem cells, including searching for a donor, bones andd conjunctive tissues, fascias, skin, tendons, cartilage tissues, heart valves, corneas and liver transplantation for children);

23. Home visits provided by medical specialists (except for home visits to psychiatric patients provided by a psychiatrist at the latter’s choice, as well as home visits to patients who need sustained artificial pulmonary ventilation);

24. Home visits provided by family doctors, except for visits to:

24.1. children under the age of 18;

24.2. the disabled with the category I;

24.3. persons who are over the age of 80;

24.4. persons who need palliative care (in the cases of specific diagnoses);

24.5. dead people who died in home conditions, in order to confirm the fact of death;

24.6. patients who need sustained artificial pulmonary ventilation;

24.7. persons who receive home care in accordance with the normative acts;

24.8. persons with cases of influenza during influenza pestilence.

25. Laboratory examinations carried out in ambulatory care (except for the examinations mentioned in Annex 6 to the regulation “Health Care Organization and Finansing Procedure”, as well as laboratory examinations necessary for children, the necessity of which has been confirmed by resolution presented by the council of the state Limited Liability Company “Children’s Clinical University Hospital”, and which corresponds to the present regulation 188.2. and the subparagraph for the afore-mentioned regulation of 188.3., its reception in other member states of the European Union and European Economic Zone (hereinafter referred to as – EU and EEZ)or in the Switzerland Confideration (hereinafter referred to as – Switzerland)); 

26. Consultations, clinical and paraclinical diagnostic examinations, which are provided in accordance with the order issued by a court medicine expert to patients in case of illegal offence. The payment for the afore-mentioned health care services is carried out by the demander of the present court medicine examination by a commission of experts;  

27. Medical rehabilitation, except for:

27.1. with the referral or recommendation provided by a physical medicine and rehabilitation doctor, if the present medicine rehabilitation is provided in accordance with the normative acts (see the regulation Nr. 1046, section  IV¹);

27.2. to those persons who got injured in the liquidation process of the consequences of Chernobyl nuclear accident and also to persons who got injured as a result of Chernobyl nuclear accident itself in accordance with the social protection law concerning persons who got injured in the liquidation process of the consequences of Chernobyl nuclear accident and also persons who got injured as a result of Chernobyl nuclear accident itself;

27.3. to patients, who need sustained artificial pulmonary ventilation;

27.4. with the referral or recommendation provided by a family doctor or any other medical specialist, receiving a consultation provided by a physical medicine and rehabilitation doctor or a rehabilitologist, as well as a consultation provided by a functional medical specialist;

28. Health care servises, which have been provided by those medical institutions or medical persons, which have no contractual relations with Health Payment Center;

29. Medical treatment provided in sanatoriums and health resorts;

30. Pozitron emission tomography examinations;

 31. Health care services provided by an art therapy medical specialist (except for rehabilitation services provided by a multi-professional team);

32. Health care services provided by a physical doctor, except for the sport medical services for children with increased physical load provided by sport medicine state agency and the legal successor of the latter’s rights and liabilities (if the present children, as extra to the programme of their primary school, elementary education or secondary education, attend sports trainings (classes) in sports and physical education institutions, sports clubs or sports federations and do not participate in sports competitions);

33. Surgical care (except for the health care services provided in ambulatory care, the surgical care provided in a day patient facility, in cases of emergency medical care, surgical care provided to children, surgical treatment in case of inflammatory intestinal diseases, surgical treatment in case of hormonally active endocrine glands, as well as surgical care in the health care services programme provided in point 2 of the Annex 22 to the present regulation);

34. Health care services in traumatology and orthopedia, except for:

34.1. in cases of emergency care provided due to traumas;

34.2. medical treatment in cases of trauma consequences treatment, as well as bones and joins disorders treatment provided by a conclusion issued by the council of traumatologists and orthopaedists;

34.3. medical treatment for osteomyelitis, purulent arthritis and soft skin infections, including spine surgery;

34.4. endoprosthetics surgeries;

34.5. oncologic diseases in bones and soft tissues treatment;

34.6. plastic endoscopic surgeries (not paid for surgeries implementing implants);

34.7. recurrent spine surgeries, if the relapse has happened in a year’s time from the date of the execution of the surgery or if there is a conclusion issued by the spine surgery council;

34.8. medical treatment for spinal dystrophy degenerative diseases (with either spinal cord symptomatology or cauda equina compression symptomatology; with progressive spine deformity with the provision of a conclusion issued by the spine surgery council);

35. External genital organs, vagina opening, and cervix uteri plastic surgeries; prolapsus correction (except for total uterus proptosis); 

36. Genetal organs inborn anomalies correction (except for correction provided to children);

37. Conservative myomectomy to patients without any clinical manifestations (bleeding, close organs failures);

38. Diagnostic hysteroscopy to determine the reasons for infertility;

39. Irretention of urine surgeries, if no urine-dynamic examinations have been carried out, which have confirmed either stress incontinence or hybrid type incontinence;

40. Planned type visual diagnostic examinations, if the latter have been carried out to patients with diagnoses, the latter, in turn, provided in Annex 41 to the present regulation;

41. Planned type diagnostic examinations in neurology, if the latter have not been carried out to patients with diagnoses, the latter, in turn, not provided in Annex 41 to the present regulation.

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