The Ministry of Labor and Vocational Training has issued a new Prakas detailing the conditions and procedures for healthcare benefits under the National Social Security Fund (NSSF). This regulation clarifies important aspects of medical treatment coverage, eligibility requirements, and service limitations.

Key Eligibility Requirements
To receive medical treatment and care services, NSSF members must:
– Be registered with the healthcare social security scheme
– Work in an NSSF-registered enterprise
– Have paid contributions for two consecutive months

Coverage Duration and Special Provisions
– Standard Coverage: Up to 180 days of medical treatment during any 12-month period at health facilities that are partners of NSSF
– Grace Period: Two months of coverage after missing contributions
– Pregnancy Exception: Continued coverage until childbirth for eligible pregnant members
– Pensioners: Automatic coverage upon receiving retirement or disability pension

Important Exclusions
The scheme does not cover several medical services, including:
– Dental care (cleaning, filling, implants)
– Cosmetic surgery
– Organ transplantation
– Laser treatment
– General health checkups
– Cardiovascular surgery
– Hemodialysis
However, these services may be covered in emergency situations.

Chronic Disease Coverage
The Prakas specifically lists 12 chronic conditions covered by the scheme, including:
– Cardiac conditions
– Chronic hepatitis B and C
– Chronic kidney disease
– Diabetes
– Cancer
– Multiple sclerosis
– Thalassemia
Treatment for these conditions must be obtained at public health facilities using essential medicines.

Health Protection Services
The scheme covers specific health protection services, including:
– Rabies vaccination and antirabic serum
– Anti-tetanus serum
– Antivenom immunoglobulin
– Various cancer markers and hormone tests

Practical Implications for Employers and Employees
1. For Employers
– Ensure timely NSSF registration and contribution payments
– Maintain proper documentation of employee coverage
– Understand coverage limitations for workforce planning

2. For Employees
– Keep NSSF membership cards valid and updated
– Understand coverage limitations and exclusions
– Follow proper procedures for emergency treatment reimbursement

Seeking Treatment
Members must present:
– Valid NSSF membership card
– Required documentation for specific services

Emergency cases can be treated at the nearest facility, with reimbursement available through NSSF’s payment mechanism.