Iran Health Insurance in Brief

Iran Health Insurance in Brief

  • Iran Health Insurance in Brief
  • More than 90% of Iranian people are under the coverage of at least one kind of health insurance. There is a positive and a negative drug reimbursement list in Iran. In general, insurance covers only 70% of the pharmacy and 90% of the hospital value of products, and then only if included on the positive reimbursement list. The health insurance organization encourages generic substitution, agreeing to pay the cost fixed at the level of the lowest-priced medicine using the same molecule, regardless of the actual price of different drugs. The government accounts for about 48% of spending on health. The private sector – including out-of-pocket spending – accounts for a majority of healthcare expenditure, private health insurance meets only 2.6% of total expenditure. Most private healthcare insurance is operated by state owned companies. The major public health insurers are as follows:
  • List of Covered Drugs
  • The latest list of drugs covered by above organizations can be accessed at their websites or the following links:
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  1. The Social Security Organization (SSO): SSO is the largest health insurance organization in Iran. All the employed citizens except for government officials and service people, contribute and receive benefit from this organization. SSO owns and operates a considerable number of clinics and hospitals in urban areas. Medical services in institutions run by SSO are offered either free of charge or at very low cost for policy holders. The SSO is the main social insurer organization responsible for compulsory coverage of wage-earners and salaried workers as well as voluntary coverage of self-employed persons. Generally, 7 million insured persons as well as 1,300,000 old-age pensioners are covered by the SSO; meanwhile, considering the family members and dependents of the major insured individuals, totally, the covered population by the SSO who receives insurance and medical services is about 27.5 million persons. For list of covered drugs click here.
  2. The Medical Service Insurance Organization  (MSIO):MSIO provides health insurance for government employees, students, and rural dwellers. The rural population not covered by any other insurance plan was entitled to receive benefits at will in 2000. Patients are subject to copayment at the point of service. For list of covered drugs click here.
  3. The Military Personnel Insurance Organization: Provides health insurance for military personnel. For list of covered drugs click here.
  4. Imam Khomeini Relief Foundation (IKRF): Provides health insurance for the uninsured poor population and supports more than 4/5 million of the deprived and the needy people in the country. For list of covered drugs click here.
  5. Private and semi-public insurance companies: Policies mainly cover copayments for costly inpatient services and cover almost 5% of the middle-class population holding none of the aforementioned insurances. The private insurance companies do not offer private “health” insurance coverage however they do offer accidental insurance for individuals, the cost of which varies with the type of coverage, age, ... etc.
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