General Healthcare System and Private Insurance
What is GHS and how does it affect private insurance?
The General Healthcare System (GHS or GESY) is an independent insurance fund through which clinics, private doctors, pharmacists, laboratories, microbiological laboratories, and physiotherapists are paid so that they can offer medical care to permanent residents of Cyprus who are paying contributions to this fund.
On 1st of June 2019, the first phase of the project had been implemented with the provision of coverage for out-patient care expenses [medicines, laboratory tests, imaging tests (Scans, x-rays, CTs, MRIs)].
The second phase was fully implemented in 2020 with the provision of inpatient coverage and rehabilitation treatment (operations, pre-operative expenses, medicines, physiotherapies).
Physiotherapists and dentists entered the system in January 2021
The system’s target is to include all clinics and doctors in Cyprus.
A small part of the clinics and doctors has not joined the GESY so far (06/2023) being afraid that this will contribute to the downgrading of the quality of their services, creating waiting lists and displeasure to their current patients.
Specifically, few of the largest clinics in Cyprus did not join the system (American Medical Center in Nicosia etc.).
On the other hand, most private clinics of Limassol and all private clinics of Paphos decided to become partners of GESY.
We, at Pitsas Insurance, believe that GESY is a mature option for a developed European country. Despite this, however, like all national health systems, it is going to face huge problems, particularly regarding the flexibility and effectiveness of the provided services.
Private insurance for inpatient care must constitute a supplementary tool so that there will be the ability for immediate medical care domestically but also flexibility regarding the option of getting medical care abroad.
For this reason, we unreservedly propose to all holders of a private insurance contract to keep it.
What are the main principles of GHS?
This system is designed to be accessible, universal and comprehensive. Let us see further down what this really means.
Accessible
The beneficiary patient can choose without any limitation the clinic or the doctor he/she likes, provided this doctor is a member of GHS (until today the 70% of doctors have entered the system).
Despite this, the patient cannot be certain that the private doctor will deal with the GESY beneficiary as quickly and flexibly as with the beneficiary of private insurance.
GESY pays a specific amount to doctors for every operation and this amount is much lower than the fees doctors used to charge up until now. It is a fact that doctors will give priority to beneficiaries of private insurances being aware that for the same operation they will be paid much more.
Specifically, according to a latest study of the University of Cyprus patients appoint a meeting with a GESY doctor with an average delay of 6 working days.
Universal
The system is designed for all people irrespective of their financial situation.
However, permanent residents of Cyprus, who do not have any form of income within the territory of Cyprus (for example salary, pension, dividends, unemployment benefits, etc) cannot have access to the system. Also, tourists are exempted.
Comprehensive
The system provides a comprehensive package of healthcare services and providers both from the private and the public sector can participate (for example all state hospitals of Cyprus participate in GESY).
Unfortunately, however, as we have already said, this system is not very flexible regarding the provision of medical healthcare abroad.
Beneficiaries of General Healthcare System (GESY)
Beneficiaries are all citizens who are permanent residents in the areas controlled by the Republic of Cyprus and come under one of the following categories:
- Cypriot citizens (workers, pensioners, recipients of benefits)
- European citizens who live and work in Cyprus or hold a permanent residence status
- Third-country nationals (non-EU citizens) who have a source of income in Cyprus. For example access to the system have businessmen who pay dividend tax and property owners who receive rentals
- Members of the families of the above categories (for example spouse, unmarried child under 18, a child who is physically or mentally handicapped, soldiers)
As a rule of thumb access to the system will have all individuals who are registered in the Social Security authorities of Cyprus and their dependents. The social security number consist of 12 numbers and it has the form 1111111/1/1111
Providers – Personal Doctors
All citizens wishing to enroll in GHS must choose a Personal Doctor (PD) who is registered in the system and who can be found at www.gesy.org.cy (the websites is also in the English language).
Beneficiaries under the age of 15 are also registered in the list of a personal doctor for children by their guardians. Personal doctors are the first contact point of beneficiaries for the preliminary diagnostic tests and for the necessary medication. If more tests are needed then the PD will refer the patient to a specialized doctor (SD).
According to the regulations, Personal Doctors are obliged to offer primary healthcare to all beneficiaries who are registered in their Beneficiaries List and to serve them on a 24-hour basis. The majority of personal doctors are even willing to issue a referral without a personal meeting after a simple phone call.
The referral is registered automatically in the system for this reason a hard copy is not required when visiting the specialised doctor.
No fee is paid after a visit to a personal doctor. However, for tests in laboratories and diagnostic centers, an amount ranging from 1-40 euros is required.
The long absence of Personal Doctor or change of Personal Doctor
When the Personal Doctor of the beneficiary is absent for a long period of time then the doctor is responsible for the appointment of another PD to replace him in case he will be away for seminars abroad, during holidays, etc.
The beneficiaries of the PD will be informed of the PD’s dates of absence as well as of his replacement.
Every six months the beneficiary has the right to change his Personal Doctor. Nevertheless, individuals should have in mind that each personal doctor has a maximum amount of registered patients. Specifically, personal doctors cannot have more than 2,500 patience registered under their name.
Access to Specialists
The Personal Doctor refers the beneficiary to Special (Specialist) Doctors. There are multiple types of referral documents. All of them last from 6 until 12 months.
There are referrals providing the opportunity from 1 until 3 visits to various doctors of the same specialty, registered in the GESY. The cost of the visits to specialised doctors usually range from 1 until 20 euro.
For women who have attained the age of fifteen and have gynecological problems no referral is needed in order for them to visit their gynecologist or obstetrician.
Similarly, for visits to dentists but also to the Accident and Emergency Department (A&E), beneficiaries can have direct access without any referral. According to the latest announcements dentists can provide for free one dental cleaning per year.
Cases Needing Medical-Healthcare Abroad
Cases needing medical healthcare abroad will go through evaluation by a special committee (Medical Council) and according to the decision made they will be sent to special centers abroad, where expenses will be covered by GESY.
This is where the value of private insurance for inpatient medical care becomes evident, so it is recommended that private insurances remain active or that one takes private insurance which will be supplementary to GESY.
The Medical Council is expected to examine hundreds of serious cases every year and as a result decision will not be made as quickly as one would have liked. Private insurances allow the bypass of bureaucracy and provide flexibility regarding the choice of a hospital abroad.
Coverage of Chronically Ill
Chronically ill patients and patients suffering from critical illnesses are covered by GESY. The target of GESY is to implement detecting and prevention programs as well as protocols to provide upgraded quality of services.
Contributions to GESY
The first phase of the GESY implementation regarding out-patient medical care began on 1st March and since then employers have been paying 1,85%, employees 1,70% of their salary and the state 1,65%.
Income earners, officials, and pensioners have been paying 1,70% and self-employed 2,55%.
As of 1st June 2020, with the implementation of the second phase of GESY which will include inpatient medical care as well, employers will be paying 2,9%, employees will be paying 2,65% of their salary, the state 4,7%, income earners, officials, and pensioners 2,65% and self-employed 4%.
Collection of GESY Contributions
Contributions will be collected by the Social Insurance Services, the Tax Department and the Treasury. Contributions are collected by the above services according to the beneficiary’s income. For example, contributions from salaries held by employers are paid to the Social Insurance Services and are then deposited to the GESY fund.
Co-Payments to GESY
Unfortunately one of the biggest misconceptions of the new system is the impression by a large part of the population that in addition to the contributions held from the salaries, everything else is free.
This conviction is wrong since for a significant group of services, like for example for tests, a relatively small amount of money will be paid.
This is a co-payment. Co-payments are specific amounts of money that the citizens will know beforehand and which will be paid to the provider for the provision of services to the beneficiary (the corresponding meaning in insurance is excess).
This is a measure that is being implemented to control abuse and the cost of the system and is aiming to ensure the responsible use of the system by the beneficiaries since there will a ceiling for co-payments.
The annual co-payment ceiling per person is:
- Low-income pensioners: €75
- General population: €300
- Recipients of benefit: €75
This means the co-payments of a beneficiary belonging to the group of pensioners will not exceed 75 euros per year, irrespective of whether he will receive extra services. The same applies to the other two categories.
Owner of private insurance plan
Citizens having a private insurance plan are not obliged to suspend their contract. The decision lies with each citizen and depends on his/her financial ability and needs. The significance of private insurance, however, is undeniable taking into consideration the speed needed for direct medical care, particularly in emergencies.
The Position of Pitsas Insurances
The positions of Pitsas Insurance (a member of MDRT) regarding GESY are fully aligned with the rest of the top insurance companies in Cyprus.
From the experience gained in international seminars and having a deep knowledge of the health system both in the United States (Obamacare) and in the United Kingdom (NHS), we believe that the general, national health system of Cyprus is a bold step for the provision of universal medical care to all citizens who reside legally in the Republic of Cyprus.
The question now is what is the role of private insurance in a universal system of medical healthcare?
The answer to this question is exactly the same as the answer given before the establishment of GESY.
The issue is not just the provision of medical care but also the quality of services accompanying it, as well as the speed with which it is being offered. When a service is public and accessible to anyone inevitably it cannot be offered in an effective and flexible way.
Long waiting lists and queues will continue. Top doctors will choose to first serve the patients who have private insurance for the very simple reason that in that case, their fees will be higher. Also, the direct provision of medical healthcare abroad will continue being a privilege of private insurance owners.
We recommend to all citizens to keep the inpatient coverage of the health insurance they have. If they wish to reduce the cost they may ask their insurance broker to add or increase the deductible amount so as to reduce the cost of the insurance.
For more information please contact us at telephone number 70070500 or send an email to [email protected]. If you wish to receive a quote for medical healthcare from leading providers (e.g. Bupa, Aetna etc.) adjusted to the new facts of GHS follow the link.
Pitsa Charalambous & Antonis Theofanous
Directors Pitsas Insurances