CNAS issued the 2nd edition of the Insured’s Guide. What rights do insured and uninsured Romanian patients have? – News from Mures, Targu Mures News

The National Health Insurance House (CNAS) in Romania developed, on March 4, 2024, the second edition of the Insurance Guide, which provides all the medical services to which Romanian patients, insured or uninsured, have access free of charge or compensated.
Quality to be insured
“The social health insurance contribution rate is 10% and is owed by individuals who have the status of employees, those who earn income for which there is an obligation to pay the social health insurance contribution, as well as by those who do not income but opts to be insured in the system”, is the condition provided in the Fiscal Code for citizens who wish to obtain the status of insured.
However, there are categories of people who acquire this quality, without paying the contribution, namely: children up to the age of 18 and young people aged 18-26, if they are students, including high school graduates, students and doctoral students, as well as people following the individual training module; husband, wife and parents with no income of their own, dependent on an insured person; pregnant women and pregnant women; disabled people; patients with conditions included in the national health programs; beneficiaries of special laws; retirees; persons who are on leave granted on the basis of Law 346/2002 (as a result of work accidents or occupational diseases); people on leave to raise a child up to two years old or, as the case may be, up to three years old; persons receiving unemployment benefit.
Packages of medical services
According to the previously mentioned guide, Romanian patients who have the quality of being insured, benefit from a basic package of medical services, which includes services provided by the family doctor, the specialist doctor in the ambulatory and hospital, paraclinical investigations, medical and palliative care at home, medicines compensated, medical devices, medical recovery, physical medicine and rehabilitation services.
Uninsured people benefit from a minimal package of medical services, consisting of the services provided in the case of medical-surgical emergencies and diseases with endemic-pandemic potential, monitoring the evolution of pregnancy and pregnancy, family planning services and preventive services.
The rights of the insured
Within the social insurance system, insured citizens have the following rights: to choose the providers of medical services, as well as the health insurance company to which they enroll; to be enrolled on the list of a deliberately chosen family doctor; to change their chosen family doctor, but not more often than once every 6 months; to benefit from the medical services mentioned above, compensated or free of charge, as the case may be; to guarantee confidentiality regarding personal data, diagnosis and treatment; to receive information about medical treatments; to benefit from holidays and social health insurance allowances, in accordance with the legislation in force.
The medical services provided by the family doctor
The family doctor represents the patients’ first medical opinion, being the patient’s first contact with the health system. The family doctor provides the insured with the medical services included in the basic package, namely: curative medical services, diagnostic and therapeutic medical services, home consultations (which are given to insured persons unable to move), medication administration services, support activities (issuance of referral tickets, medical prescriptions, medical leave certificates, etc…), preventive and prophylactic medical services, while uninsured persons benefit from the same consultations provided for in the basic package of insured persons, but the cost of laboratory analyzes is borne in full by the uninsured.
At the same time, at the family doctor, patients benefit from three annual prevention packages: annual prevention package 40+, given to people who are not on the doctor’s record with chronic diseases, which includes up to three evaluation, intervention and monitoring consultations per year ; the annual prevention package 40-60, for people registered with chronic diseases at the family doctor, which includes up to two consultations per year to detect other possible diseases, respectively the annual prevention package 60+, also intended for people already diagnosed with chronic diseases.
Also in the family doctor’s office, patients can benefit from a set of laboratory analyzes for the prevention of anemia, rickets in children, for the prevention of sexually transmitted diseases, for the prevention of metabolic symptoms, etc.
Services provided by the specialist doctor
In the framework of specialized medicine, insured persons have the right to the following medical services: services for emergency situations, curative medical services for acute conditions, consultations for chronic diseases, detection of diseases with endemoepidemic potential, consultations for the provision of family planning services (counseling, evaluation and monitoring of genito-mammary status, treatment of complications), palliative care services, diagnostic and therapeutic services, pregnancy and pregnancy surveillance services, medical services for diagnostic purposes (the latter are day hospitalization services and are provided on an outpatient basis by clinical specialty), while uninsured people have access to the following services: medical emergencies, services for the surveillance and detection of diseases with endemic-epidemic potential, as well as consultations for monitoring the evolution of pregnancy and childbirth. Access to these medical services is carried out on the basis of a referral ticket drawn up by the family doctor
Services related to the medical act
A fact less known by CNAS beneficiaries is the fact that the insured have the right to services provided by a psychologist, namely: clinical psychological assessment and psychodiagnostic service, psychological counseling and special psychopedagogy, psychotherapy. They also have the opportunity to benefit from the services offered by the physiotherapist, namely: individual or group physiotherapy, physiotherapy on special devices, such as mechanical devices, electromechanical devices, robotic devices, manual lymphatic drainage of lymphedema.
Laboratory tests
Based on a referral ticket issued by the family doctor, insured citizens have the right to the following medical laboratory tests: hematological; serum (examples: uric acid, serum creatinine, blood sugar, cholesterol, triglycerides, sodium, potassium, calcium, magnesium, etc.); urine (urine summary and sediment, urinary albumin, urinary glucose, etc.); immunological (different hormones and antibodies); microbiological (analysis of secretions, excretions, antibiogram); examination of sampled tissues; Babeș-Papanicolau test. They can be performed at any laboratory that has signed a contract with CNAS.
At the same time, radiology investigations, such as ultrasounds and high-performance investigations (CT, MRI, etc.) are settled.
Hospital admission
With regard to hospital assistance, which is granted for diseases that require hospitalization, the medical services to which the insured have access are: consultations, investigations, diagnosis, medical and/or surgical treatment, care, recovery, medicines and sanitary materials , medical devices, accommodation and meals, while uninsured people benefit from hospital services until the emergency is resolved.
Compensated drugs
Insureds can benefit from medication compensation based on a prescription drawn up by the family doctor or a specialist doctor under contract with CNAS. Doctors can prescribe drugs for a maximum period of seven days in the case of acute conditions, up to 8-10 days in the case of subacute conditions, respectively up to 30-31 days for chronic conditions. The medical prescription for chronic diseases is valid within 30 days from the date of issue, and that for acute or subacute conditions is valid within a maximum of 48 hours from the date of issue
How are sick leaves settled?
Citizens who earn income from carrying out an activity based on an individual employment contract are insured for holidays and social health insurance allowances.
The payment of sick leave is made by CNAS and by the employer, as the case may be. Medical leaves can be settled in full or in part, depending on the condition itself, as follows: ordinary illness – 75%, infectious disease from group A – 100%, infectious disease for which the measure of isolation is instituted – 100%, medical-surgical emergency – 100%, quarantine-100%, pregnancy and illness-85%, care for a sick child up to 12 years old or a child with a disability due to intercurrent conditions, up to the age of 18- 85%, care for an elderly sick child up to 12 years old or a child with a disability for intercurrent conditions, until the age of 18 – 85%, care for a sick child up to 12 years old or a child with a disability for intercurrent conditions, until the age of 18 – 100%, care for a sick child up to 12 years old or a disabled child for intercurrent conditions, up to the age of 18-75%, neoplasia, AIDS-100%, maternal risk-75%, some types of burns, including for the recovery period-100%, patient care with oncological conditions-85%, tuberculosis-100%.

Mădălina ROHAN

Photo source: Freepik