Health Insurance Fund adopts new sick leave regulations

sick leave regulations Health Insurance Fund medical criteria digital health administration patient rights

The Health Insurance Fund (FZOM) has adopted new regulations regarding the criteria for determining temporary incapacity for work. The Board of Directors clarified that these changes do not reduce sick leave rights or limit duration when medical necessity exists.

Key updates include maintaining the general practitioner's authority to determine sick leave for up to 15 days, while medical commissions will handle periods exceeding 15 days. For certain diagnoses, laboratory tests may no longer be mandatory, allowing general practitioners to make assessments directly. Additionally, for chronic conditions, existing valid diagnostic findings can be reused to prevent unnecessary repetition of tests.

Administrative improvements include the transition to electronic submission of sick leave proposals by general practitioners after the 15th day. The new rules also expand the ability to establish sick leave without the patient's physical presence, specifically for the severely ill, immobile, or hospitalized individuals. Furthermore, special provisions have been introduced to provide relief for pregnant and nursing women regarding diagnostic tests involving ionizing radiation.

Entities

DUI · Health Insurance Fund · Hristijan Mickoski · North Macedonia · SDSM · Tearce Municipality · Ursula von der Leyen · VMRO-DPMNE

Claims

What the coverage asserts, and how many sources carry each claim.

[● 4 SOURCES] Sick leave can be determined without the physical presence of the insured in cases involving the severely ill or immobile. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[● 4 SOURCES] General practitioners remain authorized to determine temporary incapacity for work for up to 15 days. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[● 4 SOURCES] After the 15th day, general practitioners will submit sick leave proposals electronically instead of manually. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[○ 1 SOURCE] The requirement for a medical council opinion for sick leave exceeding 60 days has been abolished for certain severe illnesses. 360stepeni.mk
[● 4 SOURCES] New provisions offer relief for pregnant women and nursing mothers regarding diagnostic tests involving ionizing radiation. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[● 4 SOURCES] Existing diagnostic findings can be used for chronic illnesses to avoid unnecessary repeated testing. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[● 4 SOURCES] The FZOM Board of Directors approved changes to the regulations governing temporary incapacity for work. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk
[● 4 SOURCES] The change from seven to five days for certain criteria does not mean sick leave ends on the fifth day. makpress.mk · prv.mk · skopje1.mk · 360stepeni.mk