Commitments of the Organization
By suggestion of the Health Insurance High Council of the country, limitations on the commitments of the basic health insurance medical-diagnostic services are approved by the Board of the Ministers.
Valid medical insurance book delivery is necessary for receiving services which are included in contracted medical-diagnostic centers’ commitments. (Exception of in-patient cases in those hospitals where patient reception will be done through eligibility survey’s system.)
%90 of the insured’s hospitalization costs( in hospitals and limited surgery centers) and %70 of the insured’s outpatient costs in the commitment of the organization such as: paraclinic, medicine, physicians’ visits and services provided by physicians in the offices and contracted medical-diagnostic centers are in the commitment of IHIO, according to the basic insurance package and based on the governmental tariffs approved by the Board of the Ministers. It is obvious that payment the differences between the tariffs of the private and
state sectors and some of the foreign and domestic drugs is undertaken by the insured.
The commitments of the organization for paying the expenditures of the hospitalization and outpatient sections consist of surgery, medical, paraclinic, medicine and medical equipments services are based on the basic insurance package approved by the Board of Ministers.
Paying the expenditures of some surgical operations including Plastic Surgeries, hands, feet and fingers transplants, heart transplant, liver transplant, bone marrow transplant, cochlear implantation, bladder artificial sphincter and advanced treatments of fertility like IVF are not included in the commitments of the organization (but up to %70 of the amount of some of the transplant and infertility drugs are in the commitments of basic insurance)
According to the approval of the Board of Ministers, diagnostic- medical services recently entering the health market and the other services which are out of basic insurance package are included in the commitments of complimentary insurance.
Tariffs and the pharmaceutical commitments of Iran Health Insurance Organization are accessible via this address: http://mdp.ihio.gov.ir and also the medical equipments via: http://ihio.gov.ir
To reduce the insured’s out of pocket, payment of insured share (franchises) on some drugs and specialized services for special patients and cancer patients have been decreased or omitted
New package of dental services and providing free service to the target population (children under 14 years, lactating women & pregnant women)
New package of care screening
Franchise decrease of the first level services package
Access increase of the insured to the medical service with decrease of population ratio for each physician
Providing the complementary medicines (up to %70 of the medicine cost such as Calcium D and Ferrous Sulfate is in the commitment of basic health insurance)
Funding for preparation and improvement of the host centers
Funding for promoting culture and improving the insured’s level of knowledge
Medical insurance package of addicts and developing the related systems
Covering the costs of joint replacement in the primary osteoarthritis
Reviewing the special patients ‘service package and decreasing the franchise in the secretariat of High Councils’ health insurance in MOH
Foreigners’ insurance coverage and providing services to them in frame of in-patient and temporary in-patient services in public university hospitals
Payment the expenditures of full-time physicians to decrease the number of two jobs physicians