General Organization
social insurance
No further details
In-kind or Reimbursement system
in-kind
No further details
Months of insurance to qualify for benefits
0
No further details
Is a referral required?
yes
No further details
Is there a charge for this service?
yes
Details: Up to 20% of the average amount of the total cost of the health service or drugs.
For approved health services abroad, the insured person contributes 20% of total costs, but no more than 200 euro.
Ceiling: total co-pay limit of 70% of the average monthly net salary in previous year, excluding drugs which are on the List of drugs prescribed in primary care and for treatment abroad.
Moreover, so called Preventive Government Programs provide for exemption from co-payment for health care services (except for drugs on the List of drugs issued on prescription in primary care, treatment abroad and orthopedic and other accessories). In these programs, the release is done: by type of disease and by category of insured persons.
Are there fee/co-pay reductions?
yes
Details: Low income ceiling: those with monthly net income below average monthly net salary: total co-pay limit of 40% of the average net salary in the previous year, except for the drugs which are on the List of drugs prescribed in primary care and for treatment abroad.
Poor ceiling: those with monthly net income less than 60% below average monthly net salary: total co-pay liimt of 20% of the average net salary in the contry, except for the drugs which are on the List of drugs prescribed in primary care and for treatment abroad.
Elderly ceiling: insured persons older than 65 years, ceiling of 40% of the average monthly net salary in copays, except for the drugs which are on the List of drugs prescribed in primary care and for treatment abroad.
Moreover, so called Preventive Government Programs provide for exemption from co-payment for health care services (except for drugs on the List of drugs issued on prescription in primary care, treatment abroad and orthopedic and other accessories). In these programs, the release is done: by type of disease and by category of insured persons. Additionally, there is a special “Program for providing funds for hospital treatment without payment of participation (participation) for pensioners with a pension lower than the average in the Republic of Macedonia”.
Exemption from co-payment under SPECIFIC REGULATIONS
• Disabled Veterans • Beneficiaries of family disability pension who accomplished that right as members of family of war casualty • Holders of "partisan memoirs 1941" • Holders of awarded medal "National Hero"
