Compulsory Medical Insurance Fund

Company profile

Compulsory Medical Insurance Fund company profile

Compulsory Medical Insurance Fund administers compulsory health insurance programs, contracts healthcare providers, and processes claims under a state‑guaranteed benefits package. The organization manages beneficiary enrollment, contributions, and reimbursement tariffs for outpatient and inpatient care. It operates payment models such as capitation for primary care and case‑based payments for hospitals, and maintains lists of reimbursable medicines. FOMS runs information systems for eligibility checks, billing, and analytics, and issues procedural guidance for clinics and pharmacies. It publishes procurement notices, tariffs, and statistical reports, and provides channels for inquiries from policyholders and providers. Ongoing digital initiatives include electronic claims submission and registry management to improve oversight and payment timeliness.