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Kazakhstan's social health insurance system is undergoing transformative changes, set to take effect primarily from January 1, 2026. These reforms focus on expanding coverage, ensuring financial stability, and improving benefits, particularly for low-income populations.
Key developments include:
- Expansion of Contribution Base and Coverage From January 1, 2026, the upper income limit used to calculate social health insurance contributions will increase. For employees, it will rise from 10 to 20 times the minimum monthly wage (MMW), while for employers, it will increase from 10 to 40 times the MMW. This broadens the contribution base, potentially increasing funding for the system and expanding coverage for higher-income workers.
- Balanced Funding Principles The amended Law On Obligatory Social Health Insurance introduces a principle that prioritizes individuals' self-payment of contributions alongside balanced participation from the state and employers. This shift aims to stabilize financing by sharing responsibility more equitably among stakeholders.
- Extended Benefits and Coverage Period The maximum period during which individuals can receive medical care after stopping payments has been extended from three months to six months, but only for those who have contributed regularly for at least five years. This benefits long-term contributors by reducing abrupt loss of coverage during payment gaps.
- State Reclaiming Powers and Provider Accountability The Social Health Insurance Fund gains authority to reclaim funds from healthcare providers who fail to meet contractual obligations, thereby strengthening system accountability and safeguarding financial sustainability.
- Impact on Low-Income Populations While the increase in the calculation base primarily affects higher earners and employers, extending coverage periods and rights (such as the right to choose healthcare providers) is conditional on regular contribution payment or exemptions. This may help protect low-income contributors who maintain regular payments. However, those exempt or irregular in payment are limited in benefits and choice under the amended law.
From 2026, 1 million low-income citizens in crisis or emergency levels of social well-being will be connected to the system. Individuals who are temporarily unemployed are encouraged to register officially, as this will provide protection from the local budget. City Clinic No. 4 and other similar facilities are ready to help individuals understand and complete all necessary documents for OSMSS enrollment.
Starting in 2027, Kazakhstan will transition to a full-fledged insurance model where responsibility for health is shared between the state, employers, and citizens. The maximum base for employees in the Social Medical Insurance System (OSMSS) will increase to 1.7 million tenge, setting a cap of around 34,000 tenge per month. The percentage rates in the OSMSS will remain unchanged; only the income threshold at which they are calculated will be adjusted.
The reforms in the OSMSS are centered around the patient, with a focus on expanding coverage, balancing workload between income groups, and strengthening state and local government involvement. Currently, 16.9 million people are insured, representing 82.6% of the country's population.
Local executive bodies will cover the contributions for these individuals upon their request for medical assistance. The government's contribution to the OSMSS for eligible categories will be gradually increased, reaching 4.7% by 2037.
While these reforms represent a significant step towards a more financially stable, accountable, and inclusive social health insurance system, further monitoring will be required to assess ground-level effects on rural or marginalized low-income groups.
- The planned expansion of the Social Medical Insurance System (OSMSS) in Kazakhstan from 2026 includes connecting 1 million low-income citizens, ensuring they have access to health and wellness resources.
- With the transition to a full-fledged insurance model in 2027, the focus on science and health-and-wellness will be evident, as the state will balance the contributions among itself, employers, and citizens, aiming to deliver comprehensive health services to all citizens, especially low-income groups.
