CHAPTER 395
">NATIONAL HEALTH INSURANCE FUND ACT

[PRINCIPAL LEGISLATION]

ARRANGEMENT OF SECTIONS

   Section

Title

PART I
PRELIMINARY PROVISIONS

   1.   Short title.

   2.   Application.

   3.   Interpretation.

PART II
NATIONAL HEALTH INSURANCE FUND

   4.   Establishment of the Fund and its objectives.

   5.   Management and administration.

   6.   Director-General.

   7.   Directors.

PART III
REGISTRATION AND CONTRIBUTIONS

   8.   Registration with the Fund.

   9.   Rate of contribution.

   10.   Board may vary rate of contribution.

PART IV
HEALTH CARE BENEFITS

   11.   Coverage.

   12.   Entitlement to benefit.

   13.   Portability of benefit.

   14.   Membership.

   15.   Identity card.

   16.   Benefit package.

   17.   Excluded health care services.

   18.   Disapplication.

PART V
HEALTH CARE PROVIDERS

   19.   Accreditation of health facility.

   20.   Requirements for accreditation.

   21.   Accreditation eligibility.

   22.   Categorisation of health facilities.

   23.   Choice of health care provider.

   24.   Accreditation of pharmacies.

   25.   Payment mechanism.

   26.   Quality assurance.

   27.   Monitoring mechanism.

   28.   Payment of claims.

PART VI
THE NATIONAL HEALTH INSURANCE BOARD

   29.   Establishment of the Board.

   30.   Functions and duties of the Board.

   31.   Powers of the Board.

PART VII
FINANCIAL PROVISIONS

   32.   Financial resources.

   33.   Management of funds.

   34.   Annual and supplementary budget.

   35.   Power to borrow.

   36.   Reserve Fund.

   37.   Accounts and audit.

   38.   Fund Account.

   39.   Accounts of the Board.

PART VIII
CLAIMS AND APPEALS

   40.   Claims.

   41.   Grounds for appeal.

   42.   Appeals Tribunal.

PART IX
LEGAL PROCEEDINGS, OFFENCES AND PENALTIES

   43.   Criminal proceedings.

   44.   Procedure to recover sums due to Fund.

   45.   Penalty for late payment of contribution.

   46.   Joinder in cases of non-payment of contribution.

   47.   Protection of contribution.

   48.   Protection of attachment.

PART X
GENERAL PROVISIONS

   49.   Exemption from liability.

   50.   Regulations.

   51.   Inspectors.

   52.   Bonus.

   53.   Exemptions.

   54.   Separability declaration.

   55.   Directions.

   56.   Remuneration.

SCHEDULE

CHAPTER 395
THE NATIONAL HEALTH INSURANCE FUND ACT

An Act to establish the National Health Insurance Fund and to provide for contributions to and payment of health care benefits to certain government employees and to provide for related matters.

[1st December, 1999]
[G.N. No. 320 of 1999]

Act No. 8 of 1999

PART I
PRELIMINARY PROVISIONS (ss 1-3)

1.   Short title

   This Act may be cited as the National Health Insurance Fund Act.

2.   Application

   (1) This Act shall apply to all civil servants other than those employed in the local government, defence, police, prison and those covered by the National Social Security Fund.

   (2) The Board may from time to time by Notice published in the Gazette determine any other category of members to the Fund.

3.   Interpretation

   In this Act, unless the context requires otherwise–

   "accreditation" means a process whereby the qualification and capabilities of health care providers are verified for the purpose of conferring the privilege of participation in the scheme;

   "beneficiary" means a person entitled to health care benefits under this Act;

   "benefit package" means the services offered to a beneficiary;

   "Board" means the Board of Directors of the Fund;

   "capitation" means a payment mechanism where a fixed rate is negotiated by the Fund for a specified period with a health care provider for delivery of health services due to a beneficiary;

   "child" includes a step child, a child born out of wedlock and any child to whom the member stands in loco parentis, who has not attained the age of eighteen years;

   "civil servant" means an employee of the Government, excluding local government, soldiers, police, prison officers and those civil servants covered under the National Social Security Fund Act *;

   "contribution" means the amount from salary or wages paid to the Fund by or on behalf of a member;

   "dependant" means a member of a family of a member who is wholly or in part dependent upon the member’s earning;

   "diagnostic procedure" means a procedure of analysis and examination for the identification of a disease or health condition;

   "employee" means a person who performs services for the Government as a civil servant;

   "employer" means the Government employing the services of an employee;

   "enrolment" means the process of listing individuals who are members or dependants covered by the scheme;

   "Essential Drug List" means the list of drugs for Tanzania which is prepared by the Ministry;

   "fee for service" means a fee charged by a health care provider to the Fund for past services offered to a beneficiary;

   "Fund" means the National Health Insurance Fund;

   "health care institution" includes a dispensary, health centre, hospital and any other medical clinic;

   "health care providers" means a health care institution;

   "member" means a person registered with the Fund;

   "Minister" means the Minister responsible for health matters;

   "Ministry" means the Ministry of Health;

   "peer review" means a review of the treatment of a patient or the performance of a health care provider by a professional colleague;

   "Quality assurance" means review and assurance of quality of health care service, quality assessment and corrective action to a deficiency;

   "retiree" means a member who has ceased from being a civil servant;

   "scheme" means the National Health Insurance Scheme;

   "Tribunal" means the National Health Insurance Fund Tribunal;

   "utilisation review" means the evaluation of patient utilisation or of the appropriateness of health care services.

PART II
NATIONAL HEALTH INSURANCE FUND (ss 4-7)

4.   Establishment of the Fund and its objectives

   (1) There is hereby established an autonomous institution to be known as the National Health Insurance Fund.

   (2) The Fund shall be a body corporate with perpetual succession and a common seal and, shall in its own name be capable of–

   (a)   suing and being sued;

   (b)   acquiring and holding movable and immovable property, to dispose of property and to enter into any contract or other transaction which may be performed by a body corporate lawfully.

   (3) The objectives of the Fund shall be–

   (a)   to administer the Scheme; and

   (b)   to formulate and promulgate policies for sound administration of the Scheme.

5.   Management and administration

   The management and administration of the Fund shall vest in the Board.

6.   Director-General

   (1) There shall be a Director-General of the Fund who shall be appointed by the Board and shall be responsible for the general conduct of the operations and management functions of the Fund and for other duties assigned to him by the Board from time to time.

   (2) A person shall not be qualified for appointment to be the Director-General unless he–

   (a)   has the necessary training and experience in the field of health insurance, health financing or corporate management;

   (b)   is not an interested party in any health care institution.

   (3) The Director-General shall be the Secretary to the Board.

   (4) The post of the Director-General shall be advertised and confirmed by the Board for appointment after consultation with the Minister.

7.   Directors

   There shall be other Directors of the Fund whose posts shall be advertised and confirmed by the Board for appointment.

PART III
REGISTRATION AND CONTRIBUTIONS (ss 8-10)

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