The Mandatory Health care Insurance Fund (MHIF) is a public institution of mandatory health insurance with the status of a legal entity, possessing rights, obligations, responsibilities, and special authorizations for the implementation of this law on behalf of insured persons. It is authorized to legally collect contributions and other financial resources in order to cover the costs of health care benefits to which insured persons are entitled, provided by contracted health care institutions and pharmacies, as well as all other expenses related to health insurance.

Responsibilities of the Mandatory Health Insurance Fund 

• Implements health insurance policies established by the Ministry responsible for Health.
• Ensures the implementation of this Law.
• Proposes the level or amount of contributions to be paid, co-payments, additional payments, and other financial resources for mandatory health insurance, based on an assessment of revenues and expenditures over a medium-term period, for approval by the Governing Board.
• Ensures the long-term sustainability of mandatory health insurance through forecasting demographic changes, evolving healthcare needs, advances in medical technology, and developments in healthcare delivery costs.
• Establishes and operates a comprehensive risk management framework and an internal control system.
• Oversees compliance with this Law by all natural and legal persons subject to it, by informing the Health Inspectorate of the Ministry responsible for Health and calling for action in cases of suspected non-compliance.
• Ensures the timely collection of payable contributions, transfers, and other financial resources for mandatory health insurance in accordance with this Law.
• Defines contractual conditions with healthcare institutions and pharmacies for services and products included in the benefits package, including safety, quality, cost-effectiveness, documentation, and procedural standards to be fulfilled.
• Negotiates and contracts healthcare services, including quality criteria and performance indicators for measuring outputs, outcomes, and the performance of medical documentation in healthcare institutions, including incentives for achieving defined objectives.
• With the support of the Technical Commission within the Ministry of Health, competent institutions, and experts, reviews and updates the benefits package.
• Ensures effective and timely payment for healthcare services provided by healthcare institutions based on contractual agreements.
• In cooperation with the Technical Commission responsible within the Ministry of Health, reviews and proposes the benefits package covered by the Fund to the Governing Board, including cost assessments.
• Oversees the implementation of contracts concluded by the Fund and reports to the Governing Board.
• Organizes and implements the Fund’s Health Insurance Information System and ensures interoperability with the Health Information System and other relevant Government information systems.
• Provides public information on the details of the benefits package in its official version, including annual financial statements, through the official websites of the Fund, the Ministry of Health, and the Kosovo Government portal.
• Requests actuarial analyses and financial audits of healthcare institutions that maintain contractual relationships with the Fund.
• Protects the interests of insured persons; resolves, within its competencies, claims and complaints related to health insurance matters.
• Registers and archives health insurance records and data relating to insurance status, contributions, and utilization of services in accordance with the applicable legislation.
• Compiles statistics and prepares reports.
• Organizes professional training and scientific research and engages in international cooperation in the field of health insurance.
• Concludes health insurance agreements at national and international levels, subject to approval by the Ministry responsible for Health, in accordance with the applicable legislation.
• Implements decisions and recommendations proposed by the Fund’s Complaints Committees.
• Exercises its right of recovery, takes appropriate measures, and initiates legal proceedings to recover financial damages or impose sanctions in accordance with Articles 33 and 34 of this Law.
• Regulates other matters related to mandatory health insurance in accordance with the applicable legal framework.

Supervision

The performance of the Fund is supervised by the Government through the Minister responsible for Health.