Universal Health Insurance

Universal Health Insurance

Universal health insurance is described in the Law No. 5510 as an insurance which ensures, first of all, maintenance of health statuses of individuals, and the financing of costs that arise in case the individuals experience health risks.
Introduced by the Law No.5510, universal health insurance system provides all insured and uninsured individuals who live in our country with a comprehensive, fair and equitable access to healthcare services, regardless of their economic status and whether they are willing or not.
The low-income individuals received healthcare services through “green cards” before 01.01.2012. Green card is a health card that enables our helpless and uninsured citizens with domestic monthly income per capita less than one thirds of gross minimum wage to receive healthcare services free of charge. The green card policy has been removed through some regulations and all citizens have been included in universal health insurance according to the results of means tests as of 01.01.2012.
The individuals who have green cards before 01.01.2012 and whose visa (right ownership) is valid after that date shall continue to receive healthcare benefits under universal insurance until their visas expire. It is obligatory that these individuals shall apply to the Social Assistance and Solidarity Foundations (SYDV) affiliated to the Ministry of Family and Social Policy in place of residence for taking means test no later than a month following visa expiration date. The individuals who are determined to have domestic average monthly income per capita less than one thirds of gross minimum wage according to the results of means test shall benefit from healthcare services as though they have green cards provided that health insurance premiums are paid by the State. In case domestic monthly income per capita is found more than one thirds of gross minimum wage as the result of means test, the individuals shall pay universal health insurance premium in the amount of their income.

I. Scope of Universal Health Insurance

A. Individuals deemed to be universal health insurance holders

Among the individuals having residence in Turkey;

a) Active insurance holders who;

• work on service contract,
• work as civil servants,
• work permanently in a position without subject to service contract but are not deemed to be insurance holders as working on service contract by the relevant laws,
• work under a contract but are not deemed to be insurance holders as working on service contract by the relevant laws, and are delegated directly as agents,
• work on their own names and accounts without subject to service contract and are village and neighborhood headman under the Law No. 5510,

b) Optional insurance holders,

c) Of the individuals who are not deemed to be insurance holders under above items;

• citizens whose domestic income per capita is less than one thirds of the minimum wage, to be determined through the testing methods and data to be laid down by the Institution by considering their expenses, movable and immovable properties and their rights arising from such,
• heimatlos and refugees,
• individuals over the age of 65 who receive pension,
• individuals who receive honorary pension,
• individuals who receive military service planning pension,
• individuals who receive compensation in cash and pension,
• individuals who benefit free - of - charge from protection, care and rehabilitation services
• individuals who receive disabled veteran pension and who receive pension under Law on Fighting against Terrorism,
• individuals who are charged with duty pursuant to the Village Law,
• individuals who are receiving pension due to World Olympic and European Championship

d) Provided that principle of reciprocity is also taken into consideration, individuals of foreign countries who have residence permit and are not insurance holders under legislation of a foreign country,

e) Individuals who benefit from unemployment benefit pursuant to the Unemployment Insurance Law and from short work benefit pursuant to relevant laws,

f) Individuals who receive income or pension from Social Security Institution, and

g) Citizens who are out of the above items and who do not have the right to benefit from health insurance at a foreign country,
shall be deemed to be universal health insurance holders.

The individuals who are not deemed to be insurance holder in terms of implementation of the provisions of short and long term insurance branches are also included under universal health insurance.

Also;

• Foreign students studying at universities in accordance with the Higher Education Law- provided that they pay universal health insurance premium over the amount corresponding to 30 days of the lower limit of daily earning- shall be deemed to be universal health insurance holders during their study.
• Individuals who fulfill their law internship in accordance with the Legal Profession Act without being insurance holders or dependants shall be deemed to be universal health insurance holders during their internship.

B. Individuals not deemed to be universal health insurance holders

The following individuals shall not be deemed to be universal health insurance holders:

• Individuals who fulfill their military obligations as privates and enlisted specialists, and cadets of reserve officer schools,
• Among the individuals who are sent to Turkey for a job by or on behalf of an organization established in a foreign country and who document to be subject to social insurance in the foreign country, the ones who reside in Turkey less than three months and among the individuals who work in Turkey on his/her own name and account the ones who reside abroad and are subject to the social security legislation of that country,
• Among the contracted Turkish citizen personnel, who are employed in the abroad representative offices of public administrations, the ones who document that they are insured by the social security institution of the country where they reside,
• Individuals who are prisoner or sentenced in penal institutions and detention houses,
• Among the foreigners who have residence permit but are not insurance holders under the legislation of foreign country, the ones who reside in Turkey less than one year,
• Among the individuals who are put on income or pension by the Social Security Institution through crediting, the ones who do not reside in Turkey.

II. Conditions for Benefiting from Healthcare Services

The individuals and cases listed below are held exempted from any condition for benefiting from healthcare services:

• Individuals under the age of 18,
• Individuals who are medically in need of another person,
• Traffic accidents and emergency cases,
• Work accident and occupational disease situations,
• Contagious diseases with notification obligation,
• Protective and preventive healthcare services against substance abuse and drug addiction,
• Inpatient and ambulatory treatment due to maternity,
• Disaster and war case,
• Strike and lockout cases.

In order to benefit from healthcare services and other rights, excluding the above mentioned cases, it obligatory to for individuals to fulfill the following conditions:

• The universal health insurance holders and their dependants pursuant to items of paragraph one of Article 60 of the Law No. 5510, excluding items (c) and (f), shall have totally 30 days of paid universal health insurance premiums within one year before the date of application to healthcare service provider,
• The universal health insurance holders working on their names and accounts, excluding the ones whose deferment and installment is ongoing, shall fulfill the conditions in the above item and shall not have any premium or premium - related debts over 60 days as of date of application to the healthcare service provider,
• Among the optional insurance holders and the foreigners with residence permit who do not have insurance under the legislation of a foreign country, the universal health insurance holders and their dependants shall fulfill the conditions in the above item, and shall not have any premium or premium - related debts at the date of application to the healthcare service provider,
• Foreign students studying at universities in accordance with the Higher Education Law shall pay the complete universal health insurance premiums belonging to one term within one month as of the beginning of the term.

However the individuals who are taken out of the scope of universal health insurance holder's dependant shall have totally 30 days of paid universal health insurance premiums within one year before the date of application to healthcare service provider in order to benefit from the healthcare services within 30 days following the date of being universal health insurance holder.
The insurance holders who work on service contract; the ones who work in public administrations and the self-employed shall benefit from universal health insurance for 10 days as of the termination date of their compulsory insurance. If such individuals have 90 days of compulsory insurance within one year before the date they lose their insurance status, then they and their dependants shall benefit from healthcare services for a period of 90 days following the date they lose their insurance status.

III. Services Provided Under Universal Health Insurance

A. Healthcare Services

1. Healthcare Services Financed by the Institution

The following healthcare services shall be financed by the Institution in order to ensure that the health of universal health insurance holders and their dependants are maintained, that they regain their health in case of sickness, that the health care services found necessary in medical terms as a result of work accident and occupational disease, sickness and maternity, and that the incapacity status is eliminated or reduced:

In case the individual loses the status of being universal health insurance holder, the healthcare services to be provided due to ongoing treatment shall continue until the said individual recovers.

2. Healthcare Services Not Financed by the Institution

The following healthcare services are not financed by the Institution:

IV. Financing of Universal Health Insurance

Healthcare services shall be provided in accordance with the Law No. 5510 and/or the conventions signed between the Institution and domestic and foreign health service providers by means of refunding the expenses of healthcare services purchased by universal health insurance holders and their dependants from non-contracted healthcare service providers.
The Social Security Institution shall finance the expenses made for healthcare services provided by health service providers through the premiums collected from the universal insurance holders.
Universal health insurance premium shall be 12.5% of earning subject to premium for individuals subject to short and long term insurance branches. 5% of this premium is insurance holder's share and 7.5% is employer's share.
Universal health insurance premium for individuals subject to only universal health insurance and for individuals receiving unemployment, short-term employment allowance and job loss compensation shall be 12% of earning subject to premium. The State contributes to the Institution, at a rate of one fourth of the invalidity, old - age and survivors’ insurances and universal health insurance premiums collected by the Institution per month.
Pursuant to the Law, premium income collected under universal health insurance shall not be used for the purposes other than administrative expenses, healthcare services and other rights provided by universal health insurance.