Online verification of the quality of the insured
The verification of the quality of the insured can be done online, by querying the application on the CNAS website or on the web pages of the health insurance companies.
http://cas.cnas.ro/page/verificare-asigurat.html
Online verification of the quality of the insured National Health Card
The national health card is the access code for all CNAS information systems and the tool for validating the provision of services in the public health system.
According to the data provided by CNAS, the cards are issued ex officio, through periodic extractions from the national register of insured persons.
The printing orders are sent centrally, at national level, for the persons who reach the age of 18 and / or those who acquire the quality of insured, who will receive the card through postal services. Insured persons for whom the health card has not yet been issued may benefit from medical services without presenting this document, based on the quality of the insured.
Once activated, the health card will be presented whenever the insured accesses medical or pharmaceutical services to the providers under contract with the health insurance company, except for some cases regulated by law. The provider will insert the card in the reader, and the insured will enter the PIN code.
It is important to mention that the emergency medical services do not require the use / presentation of the health card.
In case of requesting a new health card, until its receipt, the insured will benefit from medical services in the social health insurance system based on a card replacement certificate.
For the insured who refuse to receive the health card, based on a request stating the reasons for the refusal, the health insurance company periodically issues, at the request of the insured, the card replacement certificate, valid for 3 months.
The family doctor and his role
The family doctor represents the patient’s first contact with the national health system. Primary care services are based on the continuous relationship between the doctor and the person on their own list.
Anyone has the opportunity to register on the list of a family doctor of their choice. Also, after the expiration of at least 6 months from the registration date, you can opt for its change. It is important to mention that uninsured persons benefit free of charge from the minimum package, which includes medical services for emergencies, consultations to monitor the evolution of pregnancy and childbirth, family planning consultations, surveillance and detection of diseases with endemic potential, prevention services.
For laboratory analyzes, imaging investigations or the treatment recommended by the family doctor, the uninsured persons fully bear the costs, without benefiting from compensated prescriptions.
The insured benefit from the family doctor of services included in the basic package: curative medical services, prevention, home consultations, medication administration, as well as a series of additional services, which the family doctor can provide if he has the training and necessary equipment.
Curative medical services include services for medical emergencies, as well as consultations for acute illnesses (including minor surgeries or specific maneuvers). Periodic consultations for insured persons with chronic diseases are carried out on a scheduled basis and are granted for the continuation of therapy, for monitoring the evolution of the disease and its complications. Patients with chronic diseases can benefit from a monthly consultation with the family doctor, at the office or at a distance.
Family doctors who have the necessary training (certificate / competence) and equipment in the office can provide the insured on their own list of general ultrasound services – abdomen and pelvis.
Starting with July 1, 2021, family doctors who have the necessary equipment in the office, can offer insured patients from their own list the following services: spirometry, ambulatory blood pressure measurement for 24 hours (Holter), measurement of ankle pressure index- arm, performing and interpreting the electrocardiogram (EKG) to monitor confirmed cardiovascular disease.
Consultations provided by the family doctor can also be given at home for non-displaced persons, for patients with chronic diseases or acute conditions that do not allow travel to the office, children aged 0-1 years, children 0-18 years with infectious diseases and lauzelor. For patients with chronic diseases, starting with July 1, 2021, a monthly home consultation can be provided.
The family doctor can provide remote medical consultations for patients with chronic diseases, as well as for diseases with potential endemo-epidemic that require isolation. The documents resulting from the distance consultation are transmitted to the patient by electronic means of communication.
Important! For remote consultations it is not necessary to use the national social health insurance card.
Until the end of the month in which the state of alert for the COVID-19 pandemic ceases, all consultations from the basic services package, respectively from the minimum medical services package, can be granted even remotely, if the family doctor considers that this can be done. achieve for the benefit of the patient.
The medical documents that the family doctor can issue to the insured persons registered on his list:
- referral note (for specialized consultations or investigations);
- medical prescription;
- medical leave certificate;
- medical certificates for children in case of illness;
- medical certificates for enrollment in the community;
- synthetic medical file necessary for children with disabilities for inclusion and re-evaluation in the degree of disability;
- medical certificate confirming the death;
- recommendation for home medical care / palliative care at home;
- employment certificates for the unemployed beneficiaries of the basic package.
The specialist doctor
The specialized ambulatory medical assistance is provided in medical offices, health units, specialized and integrated outpatient clinics within hospitals, medical centers for diagnosis and treatment, palliative care offices, under contract with the health insurance company.
Uninsured persons can benefit from the following free medical services: medical emergencies, services for the surveillance and detection of diseases with endemic epidemic potential, as well as consultations for the surveillance of the evolution of pregnancy and childbirth.
Uninsured persons can go directly to the specialist doctor to benefit from these services, without the need for a referral ticket.
For laboratory analyzes and recommended imaging investigations and for prescribed treatment, uninsured persons will bear the full costs.
The insured have the right to the following services provided by the specialist doctor:
– medical services for emergencies,
– curative medical services for acute ailments,
– consultations for chronic diseases,
– detection of diseases with endemic-epidemic potential,
– consultations for providing family planning services (counseling, evaluation and monitoring of genito-breast status, treatment of complications),
– palliative care services,
– diagnostic and therapeutic services,
– pregnancy and maternity supervision services,
– medical services for diagnostic purposes (the latter are day hospitalization services and are provided in a specialized outpatient clinic).
The specialized medical consultation is granted on the basis of the referral ticket from the family doctor or from another specialized doctor in contract with the insurance company. The specialist doctor may issue a referral note to another specialty only during a consultation granted on the basis of a referral note issued by the family doctor, except for the conditions presented in the following paragraph, for which a referral note is not required.
In order to benefit from the second and third consultation, at the request of the specialist doctor, in order to establish the diagnosis and / or treatment, the referral ticket is no longer necessary. For emergencies and family planning services, patients can go directly to the outpatient specialist, without the need for a referral.
Also, the insured diagnosed with certain diseases (examples: diabetes, glaucoma, heart failure, multiple sclerosis, etc.), can go directly to the specialist, by appointment, without the need for a referral ticket, for a regular check-up or in case of aggravation / exacerbation of the diagnosed disease.
At least once a year, or whenever necessary, the specialist will inform the family doctor by medical letter whether or not there have been changes in the evolution of the disease and in the therapeutic attitude.
It is useful to note that patients with chronic diseases benefit, based on a referral note, a maximum of 4 consultations per quarter, with a maximum of 2 consultations per month, for services that include patient evaluation and laboratory investigations, prescribing treatment and monitoring the evolution of the disease.
For insured persons with a confirmed diagnosis upon discharge from the hospital, a maximum of 2 consultations are settled for:
- following the evolution under the treatment established during the hospitalization;
- performing therapeutic maneuvers;
- examination of the wound, removal of wires, removal of plaster, after surgery or orthopedics;
- recommendations for paraclinical investigations considered necessary, as appropriate.
Consultations for chronic diseases, as well as for diseases with endemic-epidemic potential that require isolation, can be granted remotely, by any means of communication, being exempted from the obligation to present the referral ticket from the family doctor or another doctor. specialist. The documents resulting from the consultations will be sent to the patient by electronic means.
Until the end of the month in which the state of alert for the COVID-19 pandemic ceases, all consultations from the package of basic services, respectively from the minimum package of medical services can be granted even remotely, if the specialist considers that this can be done in patient benefit.
Providing hospitalization services in private health units
According to OUG no.54 for the modification and completion of art.230 and 349 of Law no. 95/2006 on health care reform, starting with July 1, 2021, private hospitals under contract with health insurance companies may receive a personal contribution from patients who choose to benefit from hospitalization services, for a form of illness acute, in these units with financing according to diagnostic groups (DRG system).
According to the document, the personal contribution represents the difference between the tariff settled by the health insurance house and the tariff practiced by the private hospital. In order to ensure transparency and respect for patients’ rights, the following regulations have been introduced: the private hospital under contract with the health insurance company has the obligation to display publicly, at the headquarters and on the website, the fees charged and the amount settled by the state. the value of the personal contribution for the services contracted with the health insurance house.
Before hospitalization, the insured will receive an estimated estimate of the costs of the requested medical services, valid for 5 working days. Any changes in costs on the initial estimate occurred during hospitalization will be made only with the written consent of the patient or his legal partner.
Upon discharge, the patient will be issued a statement, which will include all expenses related to hospitalization. The main elements of the estimate can be found on the next page.
Release of drugs from the pharmacy
Starting with April 1, 2021, the drugs can be picked up by the insured from any pharmacy in the country, which is in contract with the health insurance houses, regardless of the health insurance house where the insured is registered by his house. of the health insurance with which the doctor is in contract, except for the medicines that are the object of the cost-volume-result contracts.
Pharmacies must ensure their supply with medicines that have a price less than or equal to the reference price, so that the insured, in case of prescription on the active substance, can opt for those products for which the health insurance houses reimburse the maximum amount, depending of the percentage related to the compensation list, and for which the personal contribution of the insured is minimal
Specifications regarding COVID-19 patients
During the COVID-19 pandemic (until the end of the month in which the alert state ceases), for insured persons, uninsured persons, as well as for other persons on the Romanian territory diagnosed with COVID-19, all necessary medical services and medicines are reimbursed from FNUASS their treatment.
At the same time, all persons on the territory of Romania who show symptoms suggestive of COVID-19 benefit from remote consultations offered by the family doctor or the specialist doctor.
Starting with July 1, 2021, in the list of medical services that can be provided in day hospitalization, the service “Assessment of Post Covid-19 Syndrome” was introduced, in order to support patients who continue to show symptoms for a long period of time. time, some even after going through a mild form of the disease.
lso, insured persons who present at hospital discharge with moderate or severe respiratory failure after COVID-19 or who have undergone a triage system specific to SARS-CoV-2 virus infection may benefit from the device for continuous oxygen administration (of oxygen concentrator type). Patients with certain conditions may benefit from noninvasive ventilation. Details on the procedure by which these equipments can be obtained are presented in the chapter Medical devices.
Starting with July 1, 2021, patients with post-COVID-19 conditions can benefit from physical therapy, psychological counseling and psychotherapy, on the recommendation of doctors in the clinical specialties of cardiology and pneumology. These services are settled in the health insurance system provided that the doctors who grant them work in clinics contracted with the health insurance companies. The way in which patients can access medical services is detailed in the chapter Specialized Doctor
Legal basis:
– HG 696/2021 for the approval of the service packages and of the Framework Contract that regulates the conditions for providing medical assistance, medicines and medical devices, technologies and assistive devices within the social health insurance system for the years 2021-2022;
– Emergency Ordinance 54/2021 for the amendment and completion of art. 230 and 349 of Law no. 95/2006 on health care reform;
– Law 95/2006 on health care reform – republished.