1. HIRA Training on Social Health Insurance from 24-28 July 2017, Seoul, Republic of Korea

2. NSSF’s Medical Claim
Presented by Mr. Sithat Sril, NSSF
July 2017

3. Outline of Presentation
1. Cambodia at a glance
2. Overview of National social Security Fund (NSSF)
3. Healthcare Scheme (SHI) on Medical Claim
Healthcare scheme started and coverage
Current flow of provider’s claim and weaknesses
Current flow of beneficiary’s claim and weaknesses

4. 1. Cambodia at a Glance Official language Khmer Area 181,035 km2
Capital
Phnom Penh
Currency
Riel (Average Exchange Rate: USD 1 = KHR 4,050)
Calling code
+855
Internet TLD
.kh
Population
15.3 million (WB-2014)
Population growth
1.54% (2008 census)
Population density
75 persons /km2 (2008 census)
Labor Force
7 million (2008 census)
Per capita GDP
$1,020 (WB-2014)
GDP
$16.7 billion (WB-2014)
GDP Growth
7.0% (WB-2014)
Inflation
3.9% (WB-2014)
Infant mortality rate
60 per 1,000 live births (2008 census)
Life expectancy
72 (WB-2013)
Median age(years)
24 (WHO-2013)

5. 2. Overview of NSSF

6. Social Health Insurance
2. Overview of NSSF
Targeted Population: (current law)
- private workers
- public employees
NSSF schemes and coverage:
Time
Nov 2008
Sept 2016
2017
2018
1. Private Worker
Work Injury
Social Health Insurance
Pension
(Plan)
2. Public Employee

7. 3. Healthcare Scheme (SHI) on Medical Claim
timeline to cover members and enterprises
Month
year
Sept 16
Oct
Nov
Dec
Jan 17
Feb
Mar
Apr
May
Jun
Total
# Covered members
248974
66805
10259
3471
1613
152237
81252
44020
35943
293
644867
# Covered enterprises
144 74 29 6 4
121 62 46 77 2
564
# Covered provinces 3 1 5
12/25

8. 3. Healthcare Scheme (SHI) on Medical Claim

9. 3. Healthcare Scheme (SHI) on Medical Claim
Provider
NSSF agent at provider
NSSF branch
NSSF headquarter
-define case name
-prepare invoices and related documents then enter into excel file provided by NSSF (from July the provider just provide the medical documents to nssf agents then received the file from agent extracted from HPSIP
-enter data consumption in HSPIS
-compare data from HSPIS system with Excel file from hospital (opd, ipd, nssf i.d

10. 3. Healthcare Scheme (SHI) on Medical Claim