Medical Treatment Program Outside Public Mandatory Health care Insurance Fund
The Government of the Republic of Kosovo, through the Mandatory Health care Insurance Fund, provides financial support for healthcare services that are not available in public health institutions.
Who can benefit?
- Citizens of the Republic of Kosovo and residents as defined by the applicable legislation, for healthcare services that are not provided by public health institutions.
Required Documentation for Application
- Original report of the Consiliary Commission, indicating the diagnosis according to the current ICD revision, signed by three (3) specialist physicians and the Director of the respective Clinic for the relevant disease, condition, or procedure;
- Copy of the applicant’s ID card or passport;
- Copy of the birth certificate (not older than six (6) months) for persons under 18 years of age;
- Other medical documentation, if available, such as discharge summaries, specialist reports, and any other documents necessary for the case to be treated;
- Proof issued by the competent authority for war invalids, immediate family members of martyrs, persons with disabilities, and/or social assistance beneficiaries, civilian war victims, in accordance with paragraph 4 of Article 10 of this Administrative Instruction;
- In cases where no reference price is available according to Annex 1 of the Administrative Instruction, three pro forma invoices from healthcare institutions in different countries where the respective healthcare service can be provided.
Application Deadlines and Review Procedure
Applications are submitted at the premises of the Mandatory Health Insurance Fund, specifically to the Division for Medical Treatment Outside Public Health Institutions.
- Applications for URGENT cases must be submitted within 72 hours (3 working days) from the date of issuance of the Consiliary Report;
- Applications for REGULAR cases must be submitted within ten (10) working days from the date of issuance of the Consiliary Report;
- For urgent cases, the Fund issues a Letter of Commitment covering medical treatment expenses in accordance with the criteria established by Administrative Instruction No. 03/2023;
- For regular cases, the Board issues a Decision in accordance with the criteria established by Administrative Instruction No. 03/2023;
- The case is forwarded to the Board for Medical Treatment Outside Public Health Institutions according to the application/completion date of the file, which, based on the assessment of the medical documentation, determines the amount of financial support;
- The Fund notifies the applicant regarding the collection of the Decision/Letter of Commitment;
- Medical treatment may commence only after receiving the Decision/Letter of Commitment from the Mandatory Health Insurance Fund.
Financial Coverage
- The Board for Medical Treatment Outside Public Health Institutions is responsible for assessing the medical documentation and approving or rejecting the financial amount for medical treatment. The determination of financial coverage is made according to the criteria set out in Article 10 of Administrative Instruction No. 03/2023.
Payment of the amount approved by the Board is made after the applicant submits the invoice and the medical report with the discharge summary (epicrisis).
Appeal Procedure
“Against the decision of the Board for Medical Treatment Outside Public Health Institutions, the party has the right to file an appeal within thirty (30) days from the date of receipt of the notification, in accordance with the applicable Law on General Administrative Procedure.”