Health Insurance for All Act, 2023

HEALTH INSURANCE FOR ALL ACT, 2023 INTRODUCTION The Tanzania Parliament enacted and published the Health Insurance for All Act through the Government in Government Gazette No.

48 of December 1, 2023 (the Act) which has the following parts: a) Health Insurance System for All b) Health Insurance Schemes c) Types of Benefits in the Schemes (Subsidies) d) Membership and Contribution to the Health Insurance Scheme e) Quality Control f) General Conditions g) Repeal of Laws and Transitional Conditions h) Amendments to various Laws i) Schedule Applicability: The Act is applicable to mainland Tanzania in matters of health care and setting conditions for facilitating access to health services to citizens through health insurance, establishing a health insurance system for all, laying down conditions for expanding the scope of various health services, establishing a system of participation in health insurance schemes for all citizens and residents, and impose the other conditions in connection therewith.

HEALTH INSURANCE FOR ALL SYSTEM Beneficiaries and compulsory requirement: It is mandatory for every Tanzanian citizen, and a foreigner aged 18 years and above who does not have health insurance recognized in Tanzania, to join the health insurance scheme under this Act. In addition, this law stipulates that the beneficiaries of this health insurance scheme for all are: employers and employees in the public sector and the formal private sector, persons who have paid in the informal sector, health insurance schemes, incapacitated people and health care centres in the country.

Regulation of the health insurance system : among other legal duties, Tanzania Insurance Regulatory Authority (TIRA) has been assigned responsibilities under this law to regulate the health insurance system for all, which include registering insurance schemes, managing the premiums offered by such schemes, safeguarding services, providing guidance to services providers on payments and efficient operation, in addition, TIRA is entrusted with the responsibility of maintaining the data of health facilities having contracts with health insurance scheme, conducting studies and discovering the effectiveness of this system as well as informing the Ministry of Health at each end of the a year on all the activities they do on this system.

HEALTH INSURANCE SCHEMES Recognizing the National Health Insurance Fund: This Act recognizes the existence of the National Health Insurance Fund and directs the Minister of Health to formulate Regulations that will facilitate the improvement of the fund to include and implement the goal of achieving health insurance for all, other private schemes will be recognized for compliance with the Directives of this Act, including being granted with a certificate by TIRA. Registration of the scheme and Cancellation of registration: TIRA is given the responsibility to maintain the registration of the new scheme and those which existed before this Act.

Also, TIRA has the power to cancel the registration of the health insurance scheme for various reasons violation of the terms of the Act, renunciation of service, dissolution of the scheme, loss of reputation or the application of the scheme itself, in addition, the Act requires TIRA to give 90 days' notice to the scheme and give it a chance to be heard before cancelling the registration.

TYPES OF BENEFITS IN THE SCHEMES (Subsidies) The Act stipulates that there shall be three types of benefits: (i) The Essential Services Bonus Scheme : This scheme is defined as one of the basic requirements of every member of the insurance scheme durable for one year. However, for all employees in the formal sector, it will last for the entire duration of the membership, the services in this section provided that they are listed in Part A of the schedule to this Act, including health care which will be available from the dispensary level to national hospitals. (ii) The Community Health Insurance Scheme : This scheme is specifically designed for persons who do not have any health insurance under the Act and in addition to the services specified in Part B of the Schedule to this Act, the beneficiaries of this scheme will receive health services to be provided in health care facilities.

Also, the Act directs the public health insurance scheme to open a special account for the funds of this scheme to be derived from the contributions of members, governments, various applicants for health insurance and account operations. (iii) The Supplementary Services Compensation Scheme: The Act allows the health insurance scheme to provide a package of essential service bonuses as an additional service to its members in whatever scheme they wish to enrol in while respecting the guidelines and procedures provided by TIRA to achieve productive competition and quality services for customers. MEMBERSHIP AND CONTRIBUTION TO HEALTH INSURANCE SCHEME Membership and benefits thereof: The Act requires a person from the formal private sector or the informal sector to join any health insurance scheme while recognizing members of preexisting schemes as members in a health insurance scheme.

In addition, there is a requirement for an employer to enrol employees in a health insurance scheme within 30 days of the date of the contract, the membership will benefit the employee, spouse and not more than four dependants and the contribution rates from the employee will take into account the rules of the scheme in question while other citizens will take into account a regulation to be drafted by the Ministry of Health. The Fund Covering the Disabled, etc.: The Act establishes a fund for the coverage of health insurance for incapacitated people. This fund will cover medical services for chronic diseases, and emergency services such as an accident in accordance with the guidelines to be issued by the Ministry of Health.

Sources of Funds: The Act defines the sources of funds for this fund as a levy and tax as may be specified by the financial authorities, funds to be allocated by Parliament, investment income of the fund etc. GENERAL CONDITIONS i. In every three years all health insurance schemes shall assess the life and sustainability of the scheme and provide information to TIRA and the Ministry of Health. ii. The investment of health insurance schemes will focus on the Directives of the Central Bank of Tanzania which, in collaboration with TIRA will supervise, review, and issue instructions regarding the operation of the scheme and the use of funds. iii. TIRA will issue guidelines on the upper limit of operating costs of the health insurance scheme. iv. Insurance Act will continue to apply to the resolution of all disputes concerning insurance.

v. The Ministry is empowered to make Regulations on all issues of registration, receipt of bonuses, improvement of the health insurance scheme, payment of claims and its investigation, all fines, diagnosis, Evidence, payment to health centers, taking action under this law, recognition of incapacitated persons, and other issues related to this Act. vi. Except for foreigners or if there is a waiver by the Minister of Health on notice, a person without valid reason who does not join the health insurance scheme within three months from the date of entry into force of this Act, when he joins will be obliged to pay 10% of the annual contribution rate as a penalty. vii. The Act will be given priority in the event of any conflict between this Act and other laws.

REPEAL OF LAWS AND TRANSITIONAL CONDITIONS The Community Health Fund Act has been repealed under section 42 of this Act, in addition, this Act continues to recognize the validity of the principles, orders, instructions, guidelines, bonuses, rights, and exemptions granted under the Community Health Fund Act until other instructions are issued by Minister of Health. AMENDMENTS TO VARIOUS LAWS The laws amended under this Act are as follows;  National Health Insurance Fund Act, Chapter 395.  Social Security Act, Chapter 135.  Insurance Act, Chapter 394.  National Fund for Social Security Act, Chapter 50.  The Law of the Child, Chapter 13.  Employment and Labor Relations Act, Chapter 366.  Private Hospital Regulation Act, Chapter 151.

SCHEDULE  Part A of the table of this rule refers to the Services to be provided in the essential services package.  Part B of the table of this law concerns the services covered by the social health insurance scheme. Disclaimer The views expressed in this paper are those of the author only and should not be considered as an official interpretation, defamatory or interference of any legislation, laws or policies of any country including Tanzania. The contents of this paper should not under any circumstances be reproduced or used without our express written consent. It should not be considered as a legal advice to any of its recipient(s) and should not be relied upon without obtaining further legal advice. We accept no liability for any loss occasioned or suffered due to the contents of this paper.