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Tanzania
National Health Insurance Fund Act
Chapter 395
- Published in Tanzania Government Gazette
- Commenced on 1 December 1999
- [This is the version of this document as it was at 31 July 2002 to 19 December 2002.]
- [Note: This legislation was revised and consolidated as at 31 July 2002 and 30 November 2019 by the Attorney General's Office, in compliance with the Laws Revision Act No. 7 of 1994, the Revised Laws and Annual Revision Act (Chapter 356 (R.L.)), and the Interpretation of Laws and General Clauses Act No. 30 of 1972. All subsequent amendments have been researched and applied by Laws.Africa for TANZLII.]
Part I – Preliminary provisions (ss. 1-3)
1. Short title
This Act may be cited as the National Health Insurance Fund Act.2. Application
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 1;"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
5. Management and administration
The management and administration of the Fund shall vest in the Board.6. Director-General
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)
8. Registration with the Fund
All contributing employers and employees shall be registered with the Fund.9. Rate of contribution
10. Board may vary rate of contribution
The Board may, under an order published in the Gazette, vary the rate of the contributions specified under section 9 as it may deem proper.Part IV – Health care benefits (ss. 11-18)
11. Coverage
12. Entitlement to benefit
13. Portability of benefit
The Fund shall develop and enforce a mechanism and procedure that shall assure benefits are portable across the areas of work within Mainland Tanzania.14. Membership
15. Identity card
16. Benefit package
17. Excluded health care services
The benefits granted under the Scheme shall not cover—18. Disapplication
The provisions of section 100 of the Employment Act 2, which relates to provision of medicine and medical treatment, and section 31 of the Workers' Compensation Act 3, which relates to medical expenses, shall not apply to employers registered with the Fund.Part V – Health care providers (ss. 19-28)
19. Accreditation of health facility
The authority to grant accreditation to a health care provider is vested into the Board.20. Requirements for accreditation
The requirements for accreditation of a health facility shall be—21. Accreditation eligibility
22. Categorisation of health facilities
Any health facility shall be categorised into different levels of accredited health facilities regardless of whether it is private or public.23. Choice of health care provider
A beneficiary requiring treatment or confinement shall be free to choose the accredited health care provider subject to the area of jurisdiction and in the case of confinement, the ceiling of such health care provider.24. Accreditation of pharmacies
In case of non-availability of drugs from a health care provider specified under the Essential Drugs List, the Board may devise a mechanism for accreditation of pharmacies.25. Payment mechanism
26. Quality assurance
A health care provider shall take part in programmes of quality assurance utilisation review and technology assessment to ensure that—27. Monitoring mechanism
28. Payment of claims
Any claim of money by a health care provider shall be paid within sixty days of presentation to the Fund for such claim.Part VI – The National Health Insurance Board (ss. 29-31)
29. Establishment of the Board
30. Functions and duties of the Board
The functions and duties of the Board shall be—31. Powers of Board
In the performance of its functions and duties the Board shall have power to—Part VII – Financial provisions (ss. 32-39)
32. Financial resources
The resources of the Fund shall consist of—33. Management of funds
The use, disposition, investment, disbursement, administration and management of funds shall be governed by resolution of the Board subject to the following limitations, namely—34. Annual and supplementary budget
35. Power to borrow
The Board may borrow moneys for the purposes of the Fund by way of loan or overdraft, and upon such security and such terms relating to the repayment of the principal and the payment of interest as the Board may deem fit.36. Reserve Fund
37. Accounts and audit
38. Fund account
The monies of the Fund shall be deemed to be funds held by the Board in trust for the members and the Government and shall be administered by the Board in accordance with the provisions of this Act.39. Accounts of the Board
The Board shall cause to be kept, maintained and audited the accounts of the Fund and the Reserve Account.Part VIII – Claims and appeals (ss. 40-42)
40. Claims
A member or a health care provider who has been aggrieved by any decision made by the officers of the Scheme may appeal to the Tribunal in accordance with the provisions of this Act.41. Grounds for appeal
The following acts shall constitute valid grounds for an appeal, namely—42. Appeals Tribunal
Part IX – Legal proceedings, offences and penalties (ss. 43-48)
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
Notwithstanding anything to the contrary contained in any other written law, in any proceedings against an employer in respect of contributions due for more than one of his employees, the magistrate may permit one plaint or one charge sheet to be made or filed in respect of all contributions claimed to be due.47. Protection of contribution
The sum standing to the credit of a member shall, until paid out in accordance with the provisions of this Act, remain the property of the Fund and shall not form part of the assets of that person in the event of his bankruptcy or insolvency or be liable to attachment in satisfaction of his debts.48. Protection of attachment
Notwithstanding anything to the contrary contained in any other written law, no execution or attachment or process of any like nature shall be issued against the contributions of any member, except in accordance with the terms of the Fund, and such contributions shall not form part of the assets of the member in the event of bankruptcy or insolvency.Part X – General provisions (ss. 49-56)
49. Exemption from liability
No act done or omitted to be done by any officer of the Fund shall, when done or omitted bona fide in execution or purported execution of his duties as such, subject any officer to any action, liability or demand.50. Regulations
51. Inspectors
52. Bonus
The Board may issue bonus to a member who did not utilise the health care services for a certain period depending on the viability of funds.53. Exemptions
Notwithstanding any other written law—54. Separability declaration
In the event of any provision under this Act or the application of such provision to any person or circumstances is declared invalid, the remainder of this Act or the application of the other remaining provisions to other persons or circumstances shall not be affected by the declaration.55. Directions
The Minister may, subject to relevant government procedures, give to the Board directions of general or specific nature as to the performance of the Board of any of its functions in relation to any matter appearing to the Minister to affect national interest, and the Board shall give effect to such directions.56. Remuneration
The Board shall determine the remuneration of its members but subject to approval by the Minister.History of this document
11 October 2021 amendment not yet applied
27 July 2012 amendment not yet applied
Amended by
Social Security Laws (Amendments) Act, 2012
06 August 2010 amendment not yet applied
26 March 2010 amendment not yet applied
20 March 2009 amendment not yet applied
09 June 2008 amendment not yet applied
Amended by
National Prosecutions Service Act, 2008
24 June 2005 amendment not yet applied
20 December 2002 amendment not yet applied
31 July 2002 this version
Consolidation
01 December 1999
Commenced
Cited documents 4
Documents citing this one 4
Judgment 2
Law Reform Report 1
Subsidiary legislation
Title
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Government Notice 11 of 2010 | |
Government Notice 491 of 2002 |