“Services in the commitment of IHIO”
- The commitments of Iran Health Insurance Organization are subject to the criteria notified by the competent authorities. According to the clause (f) of article 70 of the 6th Development Program Law, "the service package (coverage and level of services) committed by the basic health insurance funds shall be determined and announced by the Ministry of Health and Medical Education.
- Tariffs and drug obligations of Iran Health Insurance Organization are available through the site: http://mdp.ihio.gov.ir and medical equipment is available through the portal of the organization.
- Paying for some surgeries such as cosmetic surgeries, hand and foot and finger transplants (except in emergencies), heart, liver, bone marrow, cochlear implant and artificial bladder sphincter are not the responsibility of the organization. However some of the drugs used in transplantation and infertility drugs are covered by basic insurance based on the list of drugs in the service package.
- Those diagnostic and treatment services that have recently entered the health market are outside the obligations of basic insurance until the assignment is determined through the Secretariat of the High Council of Health Insurance and through the legal procedure for coverage.
- Services for the treatment of drug addiction and psychotropic drugs are covered in the form of a credit line and a designated package.
- Coverage of full-time costs of full-time physicians and full-time faculty members with the aim of strengthening education and improving the insured access to services in the university sector.
“Franchise payment for the insured”
- %90 of the inpatient services costs in hospitals and limited surgery centers and %70 of the outpatient costs in the commitment of the organization such as: paraclinic, medicine, physicians visits and office services in diagnostic-therapeutic centers contracted by IHIO are the responsibility of Iran Health Insurance organization according to the basic insurance package and based on the governmental tariffs approved by the Board of the Ministers announced by secretariat of the Supreme Council of Health Insurance. It is obvious that the insured is responsible for paying the difference between the tariffs of the private and public sectors and also some foreign and Iranian drugs, as well as non-insurance drugs and services. Meanwhile The commitments of the organization for paying the costs of inpatient and outpatient sections consisted of surgery, medical, paraclinic, medicine and medical equipments services are based on the basic insurance package.
- In order to reduce the out-of-pocket payment of the insured, the payment of the insured share (franchise) for some drugs and specialized services of special and hard to cure patients has been eliminated or reduced.