“Health Security for Your Workforce: Adherence to Health Insurance Regulations”

Comprehensive health coverage is a universal right, ensuring that every citizen has an unrestricted access to a complete array of essential healthcare services. This inclusive system, established through comprehensive health insurance, provides quality medical services without discrimination. The state, acknowledging its role, ensures healthcare affordability for those in need. The Comprehensive Health Insurance Law No. 2 of 2018, aims to reduce poverty and illness rates, offering complete medical protection in exchange for subscription payments and alleviating citizens from substantial health expenses, thereby enhancing their overall quality of life.

For efficient law implementation, the "General Authority for Comprehensive Health Insurance" was established as an independent legal entity under the Prime Minister's general supervision. This authority manages and finances the comprehensive health system, ensuring the treatment of insured individuals by designated healthcare providers until recovery, stabilization, or disability determination. Insured individuals can freely select providers among those contracted with the authority, adhering to referral levels outlined in the law and its regulations.

The General Authority for Comprehensive Health Insurance is dedicated to achieving and maintaining sustainable health coverage through social solidarity for all citizens in the Arab Republic of Egypt. This commitment ensures responsiveness to their health needs without imposing financial burdens. It involves mobilizing and consolidating financial resources to strategically procure quality healthcare services at equitable prices. The authority achieves this by contracting with an accredited network of healthcare providers in both public and private sectors, collaborating with relevant entities across all levels.

The Comprehensive Health Insurance Law includes numerous provisions that obligate private sector companies, public entities, and public business sectors to implement them in order to achieve health and social security for every employed citizen. Among the key provisions are the following:

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1.The company pledges to promptly notify the General Authority for Comprehensive Health Insurance when an insured individual is injured at work or on the related occasion. This should be done following specified procedures and timelines, using the prescribed forms. The service for the injured individual will not be terminated for any reason without ensuring the ongoing treatment for the sustained injury.

2.The company is obligated to refer the injured employee to the designated treatment facility to complete their medical care. This commitment applies even if the employee is seconded, assigned, or on a work-related assignment abroad, and their secondment or assignment period has ended, but they still require medical treatment.

3. The employer is obligated to pay the cost of the service provided by the entity responsible for determining individuals exposed to occupational diseases. This cost is determined by the General Authority for Comprehensive Health Insurance for each insured individual undergoing examination. The payment must be made within ten days from the date of the request.

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4. Employers subject to social insurance laws are required to contribute their share towards the employees' subscriptions at a rate of (4%) monthly of the subscription salary for the insured employee, at least fifty pounds per month. This contribution covers health insurance, treatment, and work-related injuries services.

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5. The employer is committed to paying the due contributions to the National Social Insurance Authority monthly. This includes both the employer's share and the portion deducted from the insured employee's salary to cover their contributions. Payments should be made on the scheduled dates for social insurance contributions.

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6. All relevant public and private entities are committed to implementing the provisions of this law by providing the General Authority for Comprehensive Health Insurance with necessary data about individuals subject to its provisions, including their geographic distribution, ages, professions, and any other information required directly for its activities.

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7. The employer is obligated to inform the General Authority for Comprehensive Health Insurance of the enrollment of all their employees or some of them who have not previously subscribed, allowing the submission application in facing the authority.

The Comprehensive Health Insurance Law includes stringent penalties for anyone attempting to deceive in order to obtain services. The law stipulates the following:

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1. In the case of non-subscription or failure to pay, individuals are required to settle overdue contributions in a lump sum or through installment payments, as determined by the General Authority for Comprehensive Health Insurance. This condition does not apply if the employer fails to remit the contributions to the authority.

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2. If the employer in the private sector or the designated employee in public entities and public business sectors fails to enroll in the General Authority for Comprehensive Health Insurance for any of the workers subject to this law or does not enroll based on their actual wages, they shall be punished with imprisonment for a term not exceeding one year and a fine of no less than five thousand pounds and not exceeding fifty thousand pounds, or with either of these penalties.

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3. If the insured individuals bear any amounts contrary to the provisions of this law, the employer or the designated employee in public entities and public business sectors shall be punished with the same aforementioned penalties, and the court may, on its own initiative, order them to reimburse the insured individuals the value of the amounts they bore.

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4. In case of delayed payment of contributions beyond the specified deadlines, the obligated party must pay an additional annual amount for the duration of the delay from the due date until the end of the payment month. The additional amount is calculated according to the rules set forth in this law.

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5. If an individual provides false information or refuses to provide the required data as specified in this law, resulting in the wrongful receipt of funds from the authority, they shall be punished with imprisonment for a period of not less than six months and a fine of not less than two thousand pounds and not exceeding ten thousand pounds, or with either of these penalties.

6. Preventing the Individuals of the authority who have the status of the judicial seizure' entry to the workplace or denying access to necessary documents under this law, intentionally providing false information, or failing to meet obligations face imprisonment for a minimum of six months, a fine ranging from twenty thousand to one hundred thousand pounds, or both penalties.

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7. If there is a deliberate submission of false claims or claims for services not provided, or allowing non-subscribers to the system to obtain services without legitimate cause, every healthcare service provider, beneficiary, or employee of the General Authority for Comprehensive Health Insurance shall be punished with imprisonment for a period of not less than one year, a fine of not less than one hundred thousand pounds, and not exceeding two hundred thousand pounds, or with either of these penalties.