DRAFT LAW GOVERNING THE ORGANISATION, FUNCTIONING AND MANAGEMENT OF HEALTH INSURANCE SCHEMES IN RWANDA EXPLANATORY NOTE

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1 1 UMUSHINGA W ITEGEKO RIGENA IMITERERE, IMIKORERE N IMICUNGIRE Y UBWISHINGIZI BW INDWARA MU RWANDA ISOBANURAMPAMVU 1. INYITO DRAFT LAW GOVERNING THE ORGANISATION, FUNCTIONING AND MANAGEMENT OF HEALTH INSURANCE SCHEMES IN RWANDA EXPLANATORY NOTE 1. TITLE PROJET DE LOI PORTANT ORGANISATION, FONCTIONNEMENT ET GESTION DES REGIMES D ASSURANCE MALADIE AU RWANDA EXPOSE DES MOTIFS 1. TITRE Umushinga w Itegeko rigena imiterere, imikorere n imicungire y Ubwishingizi bw indwara mu Rwanda. Draft Law Governing the Organisation, Functioning and Management of Health Insurance Schemes in Rwanda. Projet de loi portant organisation, fonctionnement et gestion des régimes d assurance maladie au Rwanda. 2. IMITERERE Y IKIBAZO Ubwishingizi bw Indwara butangwa n Ibigo bya Leta ndetse n Ibigo by abigenga mu Rwanda. Ibigo bya Leta bitanga ubwishingizi bw indwara birimo RAMA, MMI, na Mutuelle de Santé. Ubwishingizi bw indwara mu bikorera butangwa n ibigo byigenga nka CORAR, SORAS na AAR. 2. ISSUE Health insurance services are provided by both public and private health insurance schemes in Rwanda. Public health insurance schemes include Government Employees (RAMA), Military Medical Insurance (MMI), Community Based Health Insurance Schemes (CBHIS) as well as associations of health insurance mutual. Private health Insurance schemes are managed by private health insurance providers such as CORAR, SORAS and AAR. 2. PROBLEMATIQUE Les services d assurance maladies sont fournis par les régimes publics et privés d assurance maladie au Rwanda. Les régimes publics d assurance-maladie comprennent la Rwandaise d Assurance Maladie des agents de l Etat (RAMA), l Assurance Maladie des Militaires (MMI), et les Mutuelles de Santé. Les régimes privés d assurance maladie sont gérés par les sociétés privées d assurance telles que la CORAR, la SORAS, et AAR.

2 2 Ibigo bya Leta n Ibigo byigenga bitanga ubwishingizi bw indwara butandukanye ku bantu banyuranye bitewe n imiterere yabyo ndetse n uburyo byashinzwe. Za Mutuelles de Santé zitanga ubwishingizi bw indwara ku baturage benshi barimo abatishoboye, abakennye n abakennye cyane. Ni yo mpamvu, iri tegeko risaba ko Ibigo by Ubwishingizi bw Indwara bigira icyo bitanga ku nyungu byabonye mu mwaka mu rwego rwo gufasha za Mutuelles de Santé mu bikorwa byazo. Itegeko rishyiraho Ubwisungane mu kwivuza (Mutuelles de Santé) riteganya ko ari umunyarwanda wese n umunyamahanga bari ku butaka bw u Rwanda bagomba kugira ubwishingizi bw indwara. Ibi ndetse n andi mategeko ajyanya n ubwishingizi bw indwara bigomba gushyirwa mu itegeko rimwe bityo andi mategeko ashyiraho Ibigo bitanga ubwishingizi bw indwara akajya yo ateganya ibijyanye n imikorere bwite yabyo. Both public and private health insurance providers provide varying levels of health insurance coverage to different groups according to their structures and motives of establishment. Community Based health insurance schemes cover majority of the population some of which are categorized as poor, very poor or indigents. Therefore this law requires that all health insurance schemes donate a percentage of their annual earnings to CBHIS in order to sustain its activities. The law establishing CBHIS stipulates for compulsory health insurance for all Rwandans and foreigners who enter Rwandan territory. This and other general provisions of health insurance nature must be encompassed under a general health insurance law so that other laws or regulations that establish other health insurance schemes only creating specific health insurance schemes provide for internal organisations. Les prestataires publics et privés d assurance maladie offrent différentes sortes de couverture à des groupes différents en fonction de leurs structures et des objectifs de leur création.. Les régimes communautaires d assurance maladie couvrent une majorité de la population dont certains sont classés comme indigents, d autres pauvres ou d autres encore très pauvres. Par conséquent, cette loi exige que tous les régimes d'assurance maladie versent un pourcentage de leurs gains annuels aux Mutuelles de santé afin de soutenir leurs activités. La loi instituant le régime communautaire d assurance maladie (Mutuelles de Santé) prévoit une assurance maladie obligatoire pour tous les Rwandais et les étrangers se trouvant sur le territoire rwandais. Cette disposition et d autres dispositions relatives à l assurance maladie doivent être comprises dans une seule loi d application générale afin que les autres lois ou règlements qui établissent d autres régimes d assurance maladie prévoient pour leur organisation interne. Byongeye kandi, uyu Mushinga w Itegeko ukubiyemo ingingo rusange zari zikubiye mu mategeko anyuranye kugeza ubu Furthermore, this law encompasses general provisions that were hitherto provided for under different laws e.g. RAMA and MMI En outre, cette loi comprend des dispositions générales qui ont été jusque-ci prévues par des lois différentes, par

3 3 nk itegeko rishyiraho RAMA n irishyiraho MMI ateganya uburyo butandukanye bwo gufasha abishingirwa. provisions stipulating for different minimum healthcare packages. exemple les lois portant création de RAMA ou de MMI qui prévoient différents forfaits de soins de santé minimums. Uyu mushinga w Itegeko uteganya ishyirwaho Inama njyanama Ishinzwe Ubwishingizi bw indwara mu Rwanda ibarizwa muri Minisiteri y Ubuzima. Iyi Nama ifite mu nshingano zayo, kugenzura ibikorwa by ubwishingizi bw indwara mu gihugu cyane cyane ku bijyanye nimitangire ya serivisi nziza zo kwivuza. Ariko, nta nshingano z iyi Nama zikuraho cyangwa ngo zise n inshingano za Banki Nkuru y Igihugu ishinzwe kugenzura ibikorwa by ubwishingizi mu Gihugu. The law provides for an advisory council i.e. the Rwanda Health Insurance Council, which is placed under the Ministry of Health. The Council will be in charge of advising and supervising health insurance activities in the country in as far as access to quality health care services is concerned. However, it is important to note that none of the responsibilities of the Council overlap or substitute the responsibilities of the body in charge of regulating insurance activities i.e. the National Bank of Rwanda. La loi prévoit un organe consultatif à savoir le Conseil d Assurance Maladie au Rwanda, qui est placé sous la tutelle du Ministère de la Santé. Le Conseil sera chargé de conseiller et de superviser les activités d assurance-maladie dans le pays pour assurer l accès à des services de soins de santé de qualité. Toutefois, il est important de noter qu aucune des responsabilités de ce Conseil de ne doit chevaucher ou remplacer les responsabilités de la Banque Nationale du Rwanda qui est chargée de réglementer les activités d assurance. Abagizi iyi Nama barimo ibigo bya Leta n Ibigo byigenga bitanga ubwishingizi bw indwara. 3. INKOMOKO Y UMUSHINGA W TEGEKO Uyu Mushinga w Itegeko ufite ishingiro The composition of the Council shall include both public and private health insurance providers. 3. BACKGROUND The draft law is justified by laws La composition du Conseil doit inclure à la fois les représentants des institutions publiques et les institutions privées d assurance-maladie. 3.CONTEXTE Ce projet de loi est justifié par les lois

4 4 mu mategeko ashyiraho Ibigo by ubwishingizi bw indwara no mu yandi mategeko agenga ubwo bwishingizi mu Gihugu.Aya mategeko arimo Itegeko n 10/98 ryo kuwa 28/10/1998 ryerekeye ubuhanga bwo kuvura, Itegeko No 24/2001 ryo ku wa 27/4/2001 rishyiraho kandi rikagena imitunganyirize n imikorere y ubwishingizi bw indwara ku bakozi ba Leta, Itegeko No 62/2007 ryo kuwa 30/12/2007 rishyiraho kandi rigena imiterere, imikorere n imicungire y ubwisungane mu kwivuza, Itegeko n 07/2009 ryo kuwa 27/04/2009 ryerekeye amasosiyete y ubucuruzi, hamwe n Itegeko n 52/2008 ryo kuwa 10/09/2008 rigena imitunganyirize y umurimo w ubwishingizi. Aya mategeko ashyiraho ishingiro ry uyu Mushinga w Itegeko niwemezwa ukaba uzashyiraho imirongo ngenderwaho mu kugena amategeko n inzego bijyanye n ubwishingizi bw indwara mu gihugu. establishing health insurance schemes mentioned above and other laws governing health care in Rwanda. These include Law N 10/98 Establishing the Art of Healing,, Law N 24/2001 on the Establishment, Organization and Function of a Health Insurance Scheme for Government Employees, Law Nº 23/2005 Establishing Military Medical Insurance and Determining its Organisation and Functioning, Law N 62/2007 of 30/12/2007 Establishing and Determining the Organisation, Functioning and Management of the Mutual Health Insurance Scheme, Law N 07/2009 of 27/04/2009 Relating to Companies as well as Law N 52/2008 of 10/09/2008 Governing the Organization of insurance business. The laws provide a basis for this Draft Law which will, if approved, lay down the guidelines for a legal and institutional framework for health insurance activities in the country. établissant des régimes d assurance maladie mentionnées ci-dessus et par d autres lois qui régissent les services de soins de santé au Rwanda. Il s agit notamment de la loi N 10/98 du 28/10/1998 portant exercice de l art de guérir,, la loi n 24/2001 portant création, organisation et fonctionnement d un régime d assurance maladie des agents de l Etat, la loi n º 23/2005 instituant l assurance maladie des militaires et déterminant son organisation et son fonctionnement, la loi n 62/2007 du 30/12/2007 portant création, Organisation fonctionnement et Gestion des Mutuelles de Santé, la loi n 07/2009 du 27/04/2009 relative aux sociétés commerciales ainsi que la loi N 52/2008 du 10/09/2008 portant organisation des sociétés d assurances. Ces lois offrent une base juridique pour ce projet de loi qui, si elle est approuvée, va fixer les grandes lignes d un cadre juridique et institutionnel pour les activités d assurance-maladie dans le pays. 6

5 5 UMUSHINGA W ITEGEKO RIGENA IMITERERE, IMIKORERE N IMICUNGIRE Y UBWISHINGIZI BW INDWARA MU RWANDA ISHAKIRO DRAFT LAW GOVERNING THE ORGANISATION, FUNCTIONING AND MANAGEMENT OF HEALTH INSURANCE SCHEMES IN RWANDA TABLE OF CONTENTS PROJET DE LOI PORTANT ORGANISATION, FONCTIONNEMENT ET GESTION DES REGIMES D ASSURANCE MALADIE AU RWANDA TABLE DES MATIERES UMUTWE WA MBERE: RUSANGE INGINGO CHAPTER ONE: GENERAL PROVISIONS CHAPITRE DISPOSITIONS PREMIER: GENERALES Ingingo ya mbere: rigamije Icyo iri tegeko Article One: Purpose of this Law Article premier: Champ d application de la présente loi Ingingo ya 2: Ibisobanuro bw amagambo Ingingo ya 3: Ubwishingizi bw indwara butegetswe Ingingo ya 4: Ubwishingizi bw indwara bufatwa n Umukoresha Ingingo ya 5: Ubwishingizi bw indwara mu zabukuru Ingingo ya 6: Amoko y ubwishingizi bw indwara Article 2: Definitions of terms Article 3: Mandatory Health Insurance Article 4: Coverage by Employer Article 5: Coverage for Pensioners Article 6: Types of the health insurance Article 2: Définitions des termes Article 3: Assurance maladie obligatoire Article 4: Couverture par l employeur Article 5: Couverture pour les retraités Article 6: Types d assurance maladie

6 6 UMUTWE WA II: UBWISHINGIZI BW INDWARA BUTAGAMIJE INYUNGU Ingingo ya 7: Ibigize ubwishingizi bw indwara butagamije inyungu Ingingo ya 8: Abarebwa n ubwishingizi bw indwara butangwa n ibigo bya Leta Ingingo ya 9: Abagize umuryango b uwafashe ubwishingizi Ingingo ya 10: Imisanzu CHAPTER II: SOCIAL HEALTH INSURANCE Article 7: Composition of social health insurance Article 8: Coverage for Public Health Insurance Article 9: Beneficiaries Article 10: Contributions CHAPITRE II: ASSURANCE MALADIE SOCIALE Article 7: Composition de l assurance maladie sociale Article 8: Assurance maladie publique Article 9:bénéficiaires Article 10: Contributions UMUTWE WA III: UBWISHINGIZI BUTANGWA N UBWISUNGANE MU KWIVUZA Ingingo ya 11: Abarebwa n ubwishingizi bw ubwisungane mu kwivuza CHAPTER III: HEALTH INSURANCE COVERAGE UNDER COMMUNITY BASED HEALTH INSURANCE SCHEME Article 11: Coverage under Community Based Health Insurance Scheme CHAPITRE III : COUVERTURE D ASSURANCE MALADIE EN CAS DE REGIME COMMUNAUTAIRE D ASSURANCE MALADIE Article 11: Bénéficiaires de Mutuelles de Santé Ingingo ya 12: Umusanzu ku bwisungane mu kwivuza Article 12: Contributions to Community Based Health Insurance Article 12: Contributions aux Mutuelles de santé

7 7 UMUTWE WA IV: UBWISHINGIZI MU KWIVUZA BUTANGWA N AMASHYIRAMWE CHAPTER IV: HEALTH INSURANCE SERVICES PROVIDED BY ASSOCIATIONS CHAPITRE IV : SERVICES D ASSURANCES MALADIE OFFERTS PAR LES ASSOCIATIONS Ingingo ya 13: Abo bireba Article 13: Covered individuals Article 13 : Personnes bénéficiaires Ingingo 14: Imisanzu Article 14: Contributions Article 14 : Contributions UMUTWE WA V: UBWISHINGIZI BW INDWARA BUTANGWA N IBIGO BIHARANIRA INYUNGU Ingingo ya 15: Abarebwa n Ubwishingizi butangwa n ibigo biharanira inyungu Ingingo ya 16: Imisanzu itangwa mu bigo by ubwishingizi bw indwara biharanira inyungu Ingingo ya 17: Ibikubiye mu masezerano y ubwishingizi bw indwara butangwa n ibigo by ubwishingizi bw indwara biharanira inyungu. Ingingo ya 18: Ibisabwa gufata ubwishingizi CHAPTER V: COMMERCIAL HEALTH INSURANCE SCHEMES Article 15: Private health insurance coverage Article 16: Premiums paid to Commercial Health Insurance Article 17: Contents of commercial health insurance scheme contract Article 18: Conditions for accessing health insurance services CHAPTER V: REGIMES COMMERCIAUX D ASSURANCE MALADIE Article 15 : Couverture privée d assurance maladie Article 16 : Primes payées en cas d assurance maladie commerciale Article 17: Contenu d un contrat commercial d assurance maladie Article 18: Conditions d accès aux services d assurance-maladie

8 8 UMUTWE WA VI: INGINGO RUSANGE Ingingo ya 19: Inshingano z umwishingizi cyangwa Ikigo cy ubwishingizi bw indwara CHAPTER VI: COMMON PROVISIONS Article 19: Responsibilities of the insurer or health insurance scheme CHAPITRE VI: DISPOSITIONS COMMUNES Article 19: Responsabilités de l assureur ou d un régime d assurance maladie Ingingo ya 20: by ubuvuzi Abatanga ibikorwa Article 20: Healthcare providers Article 20: Prestataires de soins médicaux Ingingo ya 21: Ibikorwa by ubuvuzi bitangwa Ingingo ya 22: Ibikorwa by ubuvuzi byafatiwe ubundi bwishingizi Article 21: Package of healthcare benefits Article 22: Health harzards insured by other insurers Article 21: Paquet de prestations Article 22: Risques assurés par d autres assureurs Ingingo ya 23: Ikiranga uwishingiwe Article 23: Proof of insurace Article 23: Preuve d affiliation Ingingo ya 24: Igihe cyo gutangira guhabwa ubwishingizi Ingingo ya 25: Inshingano z uwishingiwe Ingingo ya 26: Kwishyura fagitiri z ibigo bitanga ubuvuzi Ingingo ya 27: Uburyo bwo gukemura impaka Ingingo ya 28: ubuziranenge muri Article 24: Period of right to access Article 25: Responsibilities of the Insured Article 26: Benefits payable to healthcare providers Article 27: Settlement of complaints Article 28: Quality assurance Article 24: Période d accès au droit Article 25: Responsabilités de l assuré Article 26: Frais payables aux prestataires de soins de santé Article 27: Règlement des plaintes Article 28: Qualité des services

9 9 serivisi Ingingo ya 29: ingamba ku gukumira imikorere mibi mu itangwa ryubuvuzi Ingingo ya 30: Ibibujijwe UMUTWE WA VII: INAMA Y UBWISHINGIZI KU BUZIMA MU RWANDA Ingingo ya 31: Inama y Igihugu y ubwishingizi bw indwara Ingingo ya 32: Inshingano z Inama UMUTWE WA VIII: IBIHANO, INGINGO Z INZIBACYUHO N IZISOZA Ingingo ya 33: Ibihano Ingingo ya 34: Itegurwa, isuzumwa n itorwa ry iri tegeko Ingingo ya 35: Ivanwaho ry ingingo zinyuranyije n iri tegeko Ingingo ya 36: Igihe cy ikurikizwa Article 29: Safeguards to prevent over or under use of healthcare services Article 30: Prohibitions CHAPTER VII: RWANDA HEALTH INSURANCE COUNCIL Article 31: Council for Health Insurance Article 32: Responsibilities of the Council CHAPTER VIII: SANCTIONS, TRANSITIONAL AND FINAL PROVISIONS Article 33: Sanctions Article 34: Drafting and consideration of this Law Article 35: Repealing of inconsistent provision Article 36: Commencement Article 29: Mesures de protection pour éviter un sous emploi ou un emploi excessif des services de santé Article 30: Interdictions CHAPITRE VII: CONSEIL D ASSURANCE MALADIE AU RWANDA Article 31: Conseil d Assurance Maladie Article 32: Attributions du Conseil CHAPITRE VIII: SANCTIONS, DISPOSITIONS TRANSITOIRES ET FINALES Article 33: Sanctions Article 34: Initiation et examen de la présente loi Article 35: Disposition abrogatoire Article 36: Entrée en vigueur

10 10 UMUSHINGA W ITEGEKO No..RYO KU WA 2011 RIGENA IMITERERE, IMIKORERE N IMICUNGIRE Y UBWISHINGIZI BW INDWARA MU RWANDA DRAFT LAW N OF GOVERNING THE ORGANISATION, FUNCTIONING AND MANAGEMENT OF HEALTH INSURANCE SCHEMES IN RWANDA PROJET DE LOI NO DU PORTANT ADMINISTRATION, ORGANISATION, FONCTIONNEMENT ET GESTION DES REGIMES D'ASSURANCE MALADIE AU RWANDA Twebwe, KAGAME Paul, Perezida wa Repubulika; We, KAGAME Paul, President of the Republic; Nous, KAGAME Paul, Président de la République; INTEKO ISHINGA AMATEGEKO YEMEJE NONE NATWE DUHAMIJE, DUTANGAJE ITEGEKO RITEYE RITYA KANDI DUTEGETSE KO RYANDIKWA MU IGAZETI YA LETA YA REPUBULIKA Y U RWANDA THE PARLIAMENT HAS ADOPTED, AND WE SANCTION, PROMULGATE THE FOLLOWING LAW AND ORDER IT BE PUBLISHED IN THE OFFICIAL GAZETTE OF THE REPUBLIC OF RWANDA. LE PARLEMENT A ADOPTE ET NOUS SANCTIONNONS PROMULGUONS LA LOI DONT LA TENEUR SUIT ET ORDONNONS QU ELLE SOIT PUBLIEE AU JOURNAL OFFICIEL INTEKO ISHINGA AMATEGEKO: THE PARLIAMENT: LE PARLEMENT: Umutwe w Abadepite, mu nama yawo yo kuwa../ ; The Chamber of Deputies, in its session of ; La Chambre des Députés, en sa séance du...; Umutwe wa Sena, mu nama yawo yo kuwa../../.; Ishingiye ku Itegeko Nshinga rya The Senate, in its session of.; Le Sénat, en sa séance du ;

11 11 Repubulika y u Rwanda ryo kuwa 4, Kamena, 2003 nk uko ryavuguruwe kugeza ubu cyane cyane mu ngingo zaryo iya 5, iya 9, iya 11, iya 41, iya 62, iya 66, iya 67, iya 88, iya 89, iya 90, iya 92, iya 93, iya 95, iya 108, iya 118 n iya 201; Pursuant to the Constitution of the Republic of Rwanda of June 4, 2003 as amended to date, especially in its articles 5, 9, 11, 41, 62, 66, 67, 88, 89, 90, 92, 93, 95, 108, 118 and 201; Vu la Constitution de la République du Rwanda du 4 Juin 2003 telle que modifiée à ce jour, spécialement en ses articles 5, 9, 11, 41, 62, 66, 67, 88, 89, 90, 92, 93, 95, 108, 118 et 201; Ishingiye ku itegeko Itegeko N 52/2008 ryo kuwa 10/09/2008 rigena imitunganyirize y umurimo w ubwishingizi cyane cyane mu ngingo zaryo iya 3 n iya 5; Pursuant to Law N 52/2008 of 10/09/2008 governing the Organization of insurance business especially in its article 3 and 5; Vu la loi N 52/2008 du 10/09/2008 portant organisation des sociétés d assurances spécialement en son article 3 et 5; Ishingiye ku itegeko N 55/2007 ryo kuwa30/11/2007 rigenga Banki Nkuru y u Rwanda; Ishingiye ku itegeko-teka N 20/75 ryo kuwa 20/Kamena/1975 rigenga n ubwishingizi muri rusange, nk uko ryavuguruwe rikuzuzwa; Ishingiye ku itegeko N 23/2005 ryo kuwa 12/12/2005 rishyiraho Ikigo cya Gisirikare cy Ubwishingizi ku ndwara rikanagena imitunganyirize n imikorere byacyo cyane cyane mu ngingo zaryo iya 23, iya 24 iya 25, iya 26, iya 27 n iya 31; Pursuant to the Law No. 55/2007 of 30/11/2007 governing the National Bank of Rwanda; Pursuant to the Decree Law N 20/75 of 20/06/1975 relating to insurance in general, as modified and completed to date; Pursuant to the Law Nº 23/2005 of 12/12/2005 Establishing Military Medical Insurance and Determining its Organisation and Functioning especially in its Articles 23, 24, 25, 26, 27, 31; Vu la Loi n 55/2007 du 30/11/2007 régissant la Banque Nationale du Rwanda ; Vu le décret n Loi 20/75 du 20/06/1975 relative à l assurance en général, telle que modifiée et complétée à ce jour; Vu la loi N º 23/2005 du 12/12/2005 portant création, organisation et fonctionnement de l assurance maladie des Militaires spécialement en ses articles 23, 25, 26, 27, 31;

12 12 Ishingiye ku Itegeko N 45/2010 ryo kuwa 14/12/2010 rishyiraho Ikigo cy Ubwiteganyirize mu Rwanda (RSSB) rikanagena inshingano, imiterere n imikorere byacyo; Ishingiye ku itegeko N 20/2000 ryo kuwa 26/07/2000 ryerekeye imiryango idaharanira inyungu; Pursuant to Law N 45/2010 of 14/12/2010 Establishing Rwanda Social Security Board (RSSB) and determining its mission, organisation and functioning; Pursuant to Law N 20/200 of 26/07/2000 relating Non-Profit making Organizations; Vu la Loi N 45/2010 du 14/12/2010 création de l Office Rwandais de Sécurité Sociale (RSSB) et déterminant sa mission, son organisation et son fonctionnement ; Vu la loi No 20/200 du 26/07/2000 relative aux organisations sans but lucratif, Ishingiye ku itegeko No 62/2007 ryo kuwa 30/12/2007 rishyiraho kandi rigena imiterere, imikorere n imicungire y ubwisungane mu kwivuza cyane cyane mu ngingo zaryo iya 5(1 ), iya 30, iya 33, iya 42 (1 ), (2 ), (4 ), iya 44, iya 45, iya 46 n iya 47; Isubiye ku itegeko No 24/2001 ryo ku wa 27/04/2001 rishyiraho kandi rigena imitunganyirize n imikorere y Ubwishingizi bw Indwara ku Bakozi ba Leta nk uko ryahinduwe kugeza ubu. Pursuant to Law N 62/2007 of 30/12/2007 establishing and determining the organization, functioning and management of the mutual health insurance schemes especially in its articles 5(1 ), 30, 33, 42 (1 ), (2 ), (4 ), 44, 45, 46 and 47; Having reviewed Law N 24/2001 of 27/4/2001 on the Establishment, Organization and Functioning of a Health Insurance Scheme for Government Employees as modified and completed to date. Vu la loi N 62/2007 du 30/12/2007 portant création, organisation, fonctionnement et gestion des Mutuelles de santé, spécialement en ses articles 5 (1 ), 30, 33, 42 (1 ), (2 ), (4 ), 44, 45, 46 et 47; Revu la loi n 24/2001 du 27/4/2001portant institution, organisation et fonctionnement d'un régime d'assurance maladie des agents de l Etat telle que modifiée et complétée à ce jour,

13 13 YEMEJE: ADOPTS: ADOPTE: UMUTWE WA MBERE: RUSANGE INGINGO CHAPTER ONE: GENERAL PROVISIONS CHAPITRE DISPOSITIONS PREMIER: GENERALES Ingingo ya Mbere: rigamije Icyo iri tegeko Article One: Purpose of this Law Article premier: Champ d application de la présente loi Iri tegeko rigenga ibikorwa by ubwishingizi bw indwara mu Rwanda. This law governs health insurance activities in Rwanda. Cette loi régit les activités maladie au Rwanda. d assurance Ingingo ya 2: Ibisobanuro bw amagambo Muri iri tegeko, amagambo akurikira afite ibisobanuro bikurikira: Article 2: Definitions of terms In this law, the following terms are defined as follows: Article 2: Définitions des termes Aux fins de la présente loi, les termes suivants sont définis comme suit: 1. Umunyamuryango ni 1. Affiliate member Any member umunyamuryango wese utanga umusanzu who meets his or her contributions under w ubwishingizi bw indwara butangwa the social health insurance scheme and a holder of a membership card mentioned n ibigo bitagamije inyungu kandi akaba under Article 23; afite ikarita y ubunyamuryango wese nk uko bivugwa mu ngingo ya 23; 2. Health insurance A mutual 2. Ubwishingizi arrangement whereby a person, group or bw indwara uburyo bushingiye household pays premiums or contributions k ubwumvikane hagati y umuntu, itsinda to a social or commercial health insurance ry abantu cyangwa se umuryango 1. «Membre affilié» Tout membre qui paie ses contributions dans le cadre d une assurance-maladie sociale et qui est titulaire d une carte d adhésion dont mention à l article 23; 2. «Assurance maladie» un accord mutuel par lequel une personne, un groupe de personnes ou un ménage paie des primes ou cotisations à un assureur public

14 14 wishyura cyangwa utanga umusanzu ku bwishingizi bw indwara, hagamijwe guhabwa ibikorwa by ubuvuzi; 3. Ibigo bitanga ubufasha mu kwivuza ibigo by ubuvuzi cyangwa abantu bakora umwuga wo kuvura bagirange amasezerano n ibigo bya Leta cyangwa by abigenga by ubwishingizi bw indwara. 4. Inama Inama y Ubwishingizi bw Indwara mu Rwanda ishyirwaho n ingingo ya 31 y iri tegeko. 5. Uwishinganisha ni umuntu cyangwa umuryango uwo ariwe wese wishyura imisanzu y ubwishingizi bw indwara cyangwa ubyishyurirwa n undi hakurikijwe amasezerano y ubwishingizi cyangwa ibigenwa n Ikigo cy ubwishingizi. 6. Umwishingizi Ikigo cy abigenga cyangwa cya Leta cyangwa ubwisungane byemerewe gukorera ibikorwa by ubwishingizi bw indwara mu Rwanda. 7. Uwishyurirwa Ku wishinganisha cyangwa se umufatabuguzi, uwishyurirwa ni uwegamiye ku uwishinganisha, uwo ni nk uwo for the purpose of receiving medical services; 3. Healthcare Facility registered health care entities that have entered into specific agreements with a social or commercial health insurance; 4. Council the Rwanda Health Insurance Council established under Article 31 of this Law. 5. Insured Any person or household who pays premiums or whose premiums are paid for by a third party as determined by a specific agreement or the insurer. 6. Insurer Any private, public or community insurance entity authorised to carry out health insurance activities in Rwanda. 7. Dependent in relation to a beneficiary or affiliate member means a spouse of an affiliate member or of the insured, a biological or legally adopted ou privé dans le but de recevoir des services de soins médicaux; 3. «Entités prestataires des soins médicaux» Les entités ou individus enregistrés qui offrent des soins médicaux et qui ont conclu des accords spécifiques avec une institution publique ou privée d assurance maladie; 4. «Conseil» Un organisme créé en vertu de l article 31 de cette loi. 5. «Assuré» Toute personne ou ménage qui paie des primes ou dont les primes sont payées par un tiers tel que déterminé par un accord spécifique ou par l assureur. 6. «Assureur» Toute entité d assurance privée, publique ou communautaire autorisée à effectuer des activités d assurance maladie au Rwanda. 7. «Personne à charge» par rapport à un bénéficiaire ou un membre affilié, il s agit du conjoint d un membre affilié ou de l assuré, un enfant biologique ou un enfant

15 15 bashakanye, umwana babyaye cyangwa uwo bareze mu buryo bwemewe n amategeko, ufite munsi imyaka itarengeje makumwabiri n umwe (21) y amavuko. 8. Uhabwa ibikorwa by ubuvuzi Ni uwishinganishije cyangwa abo areberera hakurikijwe ibyemejwe n amasezerano y ubwishingizi bw indwara. 9. Umusanzu k ubwishingizi bw Indwara butagamije inyungu mu bwishingizi bw indwara butangwa na Leta, umusanzu ni amafaranga yishyurwa n uwishinganisha cyangwa uwishyurirwa n umufatabuguzi, hakurikijwe ibyemezwa n ubwishingizi mu rwego rwo guhabwa gufashwa mu kwivuza. 10. Inyunganirabwishyu Uruhare rw uwishingiwe mu kwishyura ibikorwa by ubuvuzi yakorewe. 11. Amasezerano amasezerano ku bwishingizi bw indwara hagati y uwushinganisha n umwishingizi kugira ngo hatangwe serivisi z ubuzima ku wishinganye zishingiye ku misanzu yatanzwe. child of the affiliate member or insured, below twenty one (21) years of age. 8. Beneficiary the insured or a dependent of the insured entitled to receive healthcare services under the health insurance scheme or agreement. 9. Contribution Under social health insurance schemes, contributions are the amount paid by the insured or an affiliate member of the insurance scheme for the purpose of receiving health care services. 10. Co-payment fee A payment made by a beneficiary, usually at the time a service is received. 11. Contract the health insurance agreement concluded between the insurer and the insured, for the purpose of providing health insurance services to the insured in exchange for premiums or adopté légalement par un membre affilié ou par l assuré, qui est en dessous de vingt un (21) ans. 8. «Bénéficiaire» :l assuré ou une personne à charge de l assuré qui a le droit de recevoir des services de soins médicaux dans le cadre du régime d assurance maladie ou d un accord. 9. «Contributions» En vertu de régimes sociaux d assurance maladie, les contributions sont le montant payé par l assuré ou par un membre affilié dans le but de recevoir des services de soins de santé. 10. "Frais de co-paiement»: Un paiement effectué par un bénéficiaire, habituellement au moment où un service est reçu. 11. Contrat : l accord d assurancemaladie conclu entre l assureur et l assuré, dans le but de fournir des services d assurance-maladie pour l assuré en échange de primes ou cotisations.

16 Itsinda abantu barenze umwe bishyira hamwe kugira ngo babone uko bafata ubwishingizi bw indwara, mu rwego rusange, bahuje umwuga, ibikorwa cyangwa ubucuruzi ariko badahuje ikibazo runaka cy ubuzima. 13. Ibikorwa by ubuvuzifatizo byishyingirwaibi Ibikorwa by ubuvuzi nibura buri mwishingizi agomba guha umwishingizi bivugwa mu ngingo ya 21 y iri tegeko. 14. Ubwisungane mu kwivuza ubwishingizi mu kwivuza bw abaturage b akarere runaka, butangwa ku nyungu rusange y abanyamuryango. 15. Umuntu uri mu kiruhuko cy izabukuru Umuntu wese wemerewe guhabwa amafaranga y izabukuru kandi ugejeje ku myaka yo gufata ikiruhuko contributions. 12. Group More than one physical person who seek health insurance service with a social or common goal, purpose, profession, activity or trade. However the group shall not share a common medical or health condition. 13. Minimum health care package : A minimum package of health care services provided at a given health facility under a given health insurance scheme coverage as determined under article 21 of this law. 14. Community Based Health Insurance Scheme : means a community based health insurance scheme composed of members of the community of a given administrative district and operated exclusively for the benefit of the members. 15. Pensioner Any person who is entitled to receive pension benefits and has attained the retirement age 12. "Groupe" Plus d une personne physique qui cherche des services d assurance maladie avec un objectif social ou un même but, et qui exercent une même profession, une même activité ou commerce. Toutefois le groupe en question ne doit pas partager un problème commun lié à leur santé. 13. «Paquet de soins de santé minimums": Un ensemble de services de soins de santé offerts par un établissement de santé donné tel que déterminé en vertu de l'article 21 de cette loi. 14. "Mutuelles de Santé": un régime d assurance maladie fondé sur la communauté et composé de membres de la communauté d une circonscription administrative donnée et exploité exclusivement pour le bénéfice des membres. 15. «Pensionné: Une personne qui entre en retraite et qui est déclarée comme telle

17 17 cy izabukuru igenwa n inzego zibishinzwe mu Rwanda. 16. Umusanzu k ubwishingizi bw indwara bugamije inyungu amafaranga yishyurwa n uwishinganishije cyangwa ugenerwa ibikorwa bw ubwishingizi bw indwara cyangwa n ikigo cy ubwishingizi mu rwego rwo guhabwa serivisi zo kwivuza. 17. Ubwishingizi bw indwara butagamije inyungu ni uburyo bwo kwishyura no gucunga ubwishingizi bw indwara, hashingiwe ku ngorane abantu bashobora guhura nazo nazo, ndetse n imisanzu y abantu ku giti cyabo, abo murugo, ibigo cyangwa Leta. Ingingo ya 3: Ubwishingizi bw indwara butegetswe Umuntu wese utuye ku butaka bw u Rwanda, ategetswe kuba afite ubwishingizi bw indwara. Yaba umunyarwanda cyangwa umunyamahanga winjira mu gihugu cy u Rwanda adafite ubwishingizi bw indwara, agomba nibura yabonye ubwishingizi bw indwara mu gihe kitarengeje iminsi mirongo itatu (30) mu kigo cy ubwishingizi yahisemo. as determined by the authorities in charge of pensions in Rwanda. 16. Premiums Amount paid by the insured or an affiliate member of the insurance scheme or health insurance provider, for the purpose of receiving health care services. Define as in Law on Insurance activities. 17. Social Health Insurance (SHI) is a form of financing and managing health care based on risk pooling. SHI both the health risks of the people on one hand, and the contributions of individuals, households, enterprises, and the government on the other. Article 3: Mandatory Health Insurance Every person who resides on Rwandan territory is hereby obliged to have health insurance coverage. Any person, whether Rwandan or foreigner, who enters on Rwandan territory without health insurance coverage, shall, within a period not exceeding thirty (30) days, join a health insurance scheme of his or her choice. par les autorités compétentes. 16. «Primes»: Montant payé par l assuré ou par un membre affilié du régime d assurance ou par l assureur, dans le but de recevoir des services de soins de santé. 17. Assurance maladie sociale: une forme de financement et de gestion des soins de santé fondée sur la mutualisation des risques. L assurance maladie sociale prend en compte les risques de santé de la population d une part, et les contributions des individus, des ménages, des entreprises et celles du gouvernement d autre part. Article 3: Assurance maladie obligatoire Toute personne qui réside sur le territoire rwandais est obligé d avoir une couverture d assurance maladie. Tout rwandais ou un étranger qui entre sur le territoire rwandais sans couverture d assurance maladie, doit, dans un délai n excédant pas trente (30) jours, adhérer à un régime d assurance maladie de son choix.

18 18 Ingingo ya 4: Ubwishingizi bw indwara bufatwa n Umukoresha Yaba umukoresha wa Leta cyangwa utegamiye kuri Leta, bose bategetswe kugira uruhare mu bwishingizi bw indwara bw abakozi babo, mu kigo cy ubwishingizi cyemewe kandi cyujuje ibisabwa. Buri mukoresha wese atanga gihamya yerekana ko yatanze ubwishingizi bw abakozi be. Ingingo ya 5: Ubwishingizi bw indwara mu zabukuru Umuntu ugeze muzabukuru akomeza kwishyurirwa ubwishingizi n uwamwishingiraga mbere y uko ajya mu kiruhuko cy izabukuru. Iteka rya Minisitiri ufite ubwiteganyirize mu nshingano, rigena imiterere y imisanzu ku bari muzabukuru. Ingingo ya 6: Amoko y ubwishingizi bw indwara Ubwishingizi bw indwara bukubiye muri ibi bice bikurikira: 1 Ubwishingizi ku ndwara butangwa na Leta, 2 Ubwishingizi butangwa n abigenga. Article 4: Coverage by Employer Every public and/ or private employer is hereby obliged to participate in the health insurance benefits of their employee(s) in a recognised and registered health insurance scheme. Each employer shall provide proof of providing health insurance coverage to their employee(s). Article 5: Coverage for Pensioners A person who retires while under a public pension scheme continues to be covered by the public health insurance scheme under which he or she was a member prior to retirement. An Order of the Minister having social security under his or her attributions determines modalities and organisation of the contributions of the retiree. Article 6: Types of the health insurance The following are the types of health insurance: 1 Social health insurance, 2 Commercial health insurance. Article 4: Couverture par l employeur Tous les employeurs des secteurs public et privé doivent participer à la prise d assurance maladie de leurs employé (s) auprès d un assureur maladie reconnu et enregistré. Chaque employeur doit présenter une preuve de couverture d assurance maladie pour ses employés (s). Article 5: Couverture pour les retraités Une personne en retraite continue d être couverte par l assurance maladie dont elle a été membre avant de devenir retraitée. Un arrêté du ministre ayant la sécurité sociale dans ses attributions détermine les modalités et l organisation des contributions des retraités. Article 6: Types d assurance maladie Les types d' ssurance maladie sont les suivants: 1. L assurance maladie sociale, 2. L assurance maladie privée.

19 19 UMUTWE WA II: UBWISHINGIZI BW INDWARA BUTAGAMIJE INYUNGU Ingingo ya 7: Ibigize ubwishingizi bw indwara butagamije inyungu Ubwishingizi bw indwara butagamije inyungu bugizwe n ibi bikurikira: 1 Ubwishingizi bw indwara butangwa n ibigo bya leta, 2 Ubwisungane mu kwivuza, 3 Amashyirahamwe y ubwishingizi bw indwara. Ingingo ya 8: Abarebwa n ubwishingizi bw indwara butangwa n ibigo bya Leta Ubwishingizi bw indwara butangwa n ibigo bya Leta bureba aba bakurikira: 1 Mandateri politiki, 2 Umukozi wa Leta yaba agengwa na sitati rusange y abakozi ba Leta cyangwa n amasezerano y umurimo, 3 Umukozi ukora mu kigo cy igenga, 4 Ingabo y Igihugu, 5 Umupolisi w Igihugu, 6 Umucamanza, 7 Umushinjacyaha, 8 Umuntu uri mu kiruhuko CHAPTER II: SOCIAL HEALTH INSURANCE Article 7: Composition of social health insurance Social health insurance is composed of the following schemes: 1 Public health insurance schemes, 2 Community based health insurance schemes, 3 Mutual health insurance associations. Article 8: Coverage for Public Health Insurance Public health insurance covers health care services for: 1 Political appointee, 2 Government employee whether governed by the general statute for Government employees or contract, 3 private sector employees 4 A member of the Rwanda Defence Forces, 5 Member of the national police, 6 A judge, 7 A prosecutor, CHAPITRE II: ASSURANCE MALADIE SOCIALE Article 7: Composition de l assurance maladie sociale L assurance maladie sociale se compose des régimes suivants: 1. Les régimes publics d assurance maladie, 2. Les Mutuelles de santé, 3. Les Associations d assurance maladie Article 8: Assurance maladie publique Les régimes publics d assurance-maladie couvrent les catégories des personnes suivantes: 1. Les mandataires politiques ; 2. Les agents de l Etat sous statut ou sous contrat ; 3. Les employés au sein du secteur privé ; 4. Les militaires ; 5. La Police ; 6. Les juges ; 7. Les procureurs ; 8. Les retraités

20 20 cy izabukuru. Uretse abikorera ku giti cyabo cyangwa ibigo by igenga bihitiramo ibigo by ubwishingizi bw indwara butangwa n ikigocy ubwishingizi icyo aricyo cyose, ibigo by abigenga biharanira inyungu, ubwisungane mu kwivuza no mu mashyirahamwe mu kwivuza, abandi bavugwa muri iyi ngingo bagomba gufatirwa ubwishingizi bw indwara mu bigo bya leta. Uburyo abavugwa mu gika cya mbere cy iyi ngingo bashyirwa muri ubwo bwishingizi bw indwara bucungwa n ibigo by Leta bugenwa n iteka rya Perezida. Abagize umuryango bemewe n amategeko b uwafashe ubwishingizi bishyingirwa kimwe na nyir ubwite. Uburyo umuntu ku giti cye n uri mu kiruhuko cy izabukuru bafata ubwishingizi butangwa n ikigo cya Leta biteganywa n Iteka rya Minisitiri ufite ubwiteganyirize mu nshingano ze. Ingingo ya 9: Abagize umuryango b uwafashe ubwishingizi Abagize umuryango b uwafashe ubwishingizi ni aba bakurikira: 8 Retired person. Apart from the self-employed individual or private institutions who may choose a given health insurance scheme of their choice, other categories mentioned in the first paragraph of this Article are obliged to be affiliated to public health insurance schemes. An order of the President determines the modalities for their affiliation to the respective public health insurance schemes. Coverage for affiliate member applies to his or her dependents. Conditions of affiliation to public health insurance scheme by the self-employed and retired individuals are determined by an Order of the Minister having social security in his or her attributions. Article 9: Beneficiaries Are beneficiaries of the insured for public health insurance services: 1 Legally married spouse, A part les personnes qui travaillent pour elles-mêmes ou pour les institutions privées qui peuvent choisir un régime public d assurance maladie donné de leur choix, les autres catégories de personnes mentionnées au paragraphe premier de cet article doivent être affiliées à un régime public d assurance maladie. Un arrêté présidentiel détermine les modalités de leur affiliation à un régime public d assurance maladie. La couverture d un membre affilié s applique aux personnes à sa charge. Un arrêté du ministre ayant la sécurité sociale dans ses attributions détermine les conditions d affiliation des personnes qui travaillent pour elles-mêmes et des personnes retraitées à un régime public d assurance maladie. Article 9:bénéficiaires Les bénéficiaires de l assuré auprès d un régime public d assurance maladie sont : 1. Le conjoint légalement marié de

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