About 3 million dental services were paid by the Social Health Insurance Fund for January-August 2020.
For 8 months of this year, the Social Health Insurance Fund paid 5.1 billion tenge for the provision of more than 2.8 million dental services to the population.
Including provided about 650 thousand services to children under 18 years of age and pregnant women in a planned manner, 2.1 million urgent dental services to certain categories of the population, as well as 1 707 orthodontic services for children.
Recall that routine dental care in the compulsory health insurance system is provided to children under 18 and pregnant women.
Emergency dental care in the OSHI system can be received by children under 18 years of age, pregnant women, participants in the Great Patriotic War, disabled persons of groups 1, 2, 3, mothers with many children, “Altyn alka”, “Kumis alka” awarded pendants, recipients of targeted social assistance, pensioners by age, patients with socially significant diseases, non-working persons caring for a disabled child, non-working persons caring for a disabled person of the first group since childhood.
Orthodontic care is provided to children under 18 years of age with congenital pathology of the maxillofacial region using an apparatus for eliminating dentoalveolar anomalies.
Also, starting this year, the Social Health Insurance Fund under the compulsory health insurance package provides for support of children from socially unprotected families – recipients of targeted social assistance. Children aged 6 to 12 years will be provided with orthodontic care for various types of dentoalveolar anomalies (bite defects, jaw microgliosis). More than 9 thousand children will receive this assistance, 415 million tenge is provided for it by the end of the year.
“For dental care, a patient can apply to both a polyclinic and a dental clinic. At the same time, it is important that the clinic providing dental services is a potential supplier of the Fund and is in the register of potential suppliers, ”the Social Insurance Fund notes.
As of September 1, 2020, 626 dental providers are providing dental services nationwide. Among them, there are 346 state and 280 private clinics. This year, the number of providers of the Fund has grown compared to 2019, so last year 522 providers provided dental care, including 315 state-owned and 207 private.
“The provision of emergency and planned dental care is carried out on the basis of the patient’s free choice (in the case of a child, a parent or legal representative) and does not require a referral from a district doctor at the place of attachment of the patient. The fact of the provision of services and the amount of dental care are registered in the information system, which is the basis for concluding a co-execution agreement between the PHS organization and dental clinics, which is generated in the information system automatically, ” explained in the Fund.
Payment for the services provided is carried out through the organization of primary health care (polyclinic) at the place of attachment of the patient.
Please note that the services rendered are entered into the information system upon delivery.
In case of refusal to provide medical assistance, you must contact the Social Health Insurance Fund using the Qoldau 24/7 mobile application, which can be installed in the Play Market and App Store.