Address by Directors Sasho Klekovski and Branko Adzigogov

The Directors informed about the legal amendments that were adopted on 10.07.2025 by the Assembly of the Republic of North Macedonia, proposed by a group of Members of Parliament and prepared with the participation of the Health Insurance Fund.

Main novelty: Better biomedical assisted fertilisation (BAF) 

The amendments are:

• Inclusion of BAF in the basic package of health services;
• Increase to 6 instead of 3 BAF attempts covered by the Fund;
• Harmonisation of the exemption from co-payment;

In addition, the Fund has:

• Shortened the decision-making time from 3 months to 2 weeks;
• Digitalised the process, at this stage towards applicants, including the BAF voucher;
• Simplified part of the administrative process;

An increasing number of married couples and individuals are facing problems with conception, and treatment success often increases with a higher number of attempts. We are taking a step to support one of the most fundamental human aspirations – creating a family!

Several pieces of information on BAF for 2024

• 1.495 applications for BAF, of which 1.280 for a first child, 195 for a second child, 15 for a third child and 5 for a fourth child
• A maximum amount of around 93.000 MKD per attempt, and for 1.106 completed BAF attempts, 89.547.990 denars were used 
• BAF procedures performed in 8 health institutions.

Next steps of the Fund:

• Financial support for cryopreservation, namely freezing egg cells for future use
• Support for the Gynaecology Clinic in establishing a national bank of reproductive material (egg cells and sperm) to increase access to reproductive treatments.

Application information: here

Second novelty: Facilitation of treatment abroad

The recommendations of the State Audit Office are being applied to facilitate treatment abroad:

• The second-instance commission will decide only on appeals, no longer also on opinions of the first-instance commission, thereby shortening the process and ensuring two-instance proceedings;
• The decision-making deadline is shortened from 45 to 30 days;
• The conclusion of agreements with foreign hospitals is deleted due to inapplicability.

In 2024, 273 treatments abroad were approved for a total of 488 million denars or around 

1.8 million denars per treatment. In the first half-year, out of 173 applications, 154 applications were approved for 239 million denars.

Third novelty: Return to one Director as the managing body

The concept of a managing body of the Fund consisting of two Directors who are equally responsible for the Fund’s operations is being abandoned and the concept of a Director and Deputy Director, which existed until 2007, is being restored.

Other novelties

Equalisation of rights for foreigners with regulated residence

The process has begun under which foreign nationals with regular residence in the country will have equal rights from compulsory health insurance as our citizens. One more law, on compulsory social insurance, needs to be amended.

The appeals procedure is transferred to the competence of the State Commission, and not the Ministry of Health

Transfer of the second-instance appeals procedure for deciding on appeals against first-instance decisions of the Fund from the Ministry of Health to the State Commission for Decision-Making in Administrative Procedure, Employment Procedure and Second-Instance Inspection Supervision, without a transitional period.

The amendments send a clear message:

• We are expanding the rights of insured persons;
•  We are modernising the system;
• We are creating a fairer, more functional and more accessible health system.

The Directors were available for all additional questions.