Some medical consultations fall outside insurance coverage: minister (PAN.am)

Health Minister Anahit Avanesyan, addressing reimbursement procedures for medical services provided to children under the insurance system during a Facebook livestream, said there are cases in which health insurance does not reimburse consultations.

“Yes, there are cases when health insurance does not reimburse consultations because, for example, the proper pathway has not been followed — first the polyclinic and then the hospital. The citizen has gone directly to the hospital for a scheduled consultation. Insurance will not reimburse this,” she said.

Avanesyan said health insurance has established a clearly defined scope of services for which reimbursement is provided.

The minister added that in some cases, a consultation with a particular specialist may involve a co-payment, which is also regulated.

“Not all healthcare services can be covered by insurance,” Avanesyan said.

The universal health insurance system began operating on Jan. 1, 2026. In the initial stage, it covered citizens earning salaries of 200,000 drams or more. The first stage also included all people under 18 and those aged 65 and older, regardless of income level. The state will provide 100% financing for these groups in 2026. The mandatory insurance package costs 129,600 drams annually and includes preventive and early-detection programs, screenings, hospital treatment, medication coverage and emergency medical services. For people earning 200,000 to 500,000 drams, the state covers most of the cost, leaving them to pay only 300 drams per month, as a significant portion of funds directed to the ZINAPAH Foundation is redirected to the insurance system.