~90Irl\ ., ;J&T ;JtLlIJ FEDERAL NEGARIT GAZETA

OF THE FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

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17'h Year NO.4 ADDISABABA2" December 2010

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CONTENTS

Regulation No. 191 /20 10 The Ethiopian Health ·lnsurance Agency

Establishment Council of Minister Regulation ......... .......... Page 5673

COUNCIL OF MINISTERS REGULATION No. 191 /2010 COUNCIL OF MINISTERS REGULATION TO

PROVIDE FOR THE EST ABLlSHMENT OF THE ETHIOPIAN SOCIAL HEAL TH INSURANCE

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AGENCY This Regulation is issued by the Council of Ministers pursuant to Article 5 and 34 of the Definitions of Powers and Duties of the Executive Organs of the Federai Democratic Republic of Ethiopia Proclamation No. 691/20 I O and Article IO of the Social Health Insurance Proclamation No. 690/2010. li. b~C C6fl

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l. Short Title

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This Regulation may be cited as the "Ethiopian Health Insurance Agency Establishment Council of Ministers Regulation NO.191 /20 IO" .

Definitions

In this Regulation, unless the context otherwise reqUires: t

II "Proclamation" means the Social Health Insurance Proclamation No. 690/2010;

21 "Ministry' means the Ministry ofHealth;

31 any expression in the masculine gender include the feminine. c.

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3, Establishment

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I I The Ethiopian Health Insurance Agency (hereinafter the "Agency") is hereby established as an autonomous federai organ having its own legai personality.

21 The Agencyshall be accountable to the Ministry.

Head Office

The Agency shall have its head office in Addis Ababa and may have branch offices elsewhere as deemed necessary.

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The objective of the Agency shall be to implement

the health insurance system.

6. Powers and Duties or the Agency

The Agency shalI have the powers and duties to:

II establish and implement efficient and effective

health insurance system;

21 colIect and administer monthly contributions of

the social health insurance system;

31 conclude contracts with and effect payment to

accredited health service providers and monitor

their perfOllllances;

41 receive and investigate suggestions and

complaints by members regarding service

provision and provide appropriate solutions;

51 ensure that health insurance is being

implemented in alI institutions required to

implement it;

61 create conducive conditions to expand and

strengthen health insurance, encourage and

coordinate those engaged in .thé-field; •

71 undertake public education and sensitization on

health insurance;

81 undertake studies for revision of the benefit

package and amount of contributions; present

the result with recommendations to the Ministry;

implement same when approved by the

govemment;

91 where necessary, establish different committees,

guide and coordinate their activities;

101 make investrnents pursuant to directives of the

govemment;

Ili take measures to ensure the financial

sustainability ofthe health insurance system;

12/0wn property, enter into contracts and sue and

be sued in its own name;

131 delegate part of its powers and duties to

institutions as deemed necessary;

141 perfOlIll other activities as may be necessary for

the attainment of its objectives;

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l/a Management Board (herein referred as the

"Board");

21 a Director GeneraI and Deputy Director

Generals to be appointed by the govemment;

and

3/ the necessary staff.

8. Members ofthe Board

11 Members of the Board shall be designated by the govemment and shall have the following composition:

a) one member representing the Confederation of Ethiopian Trade U,ions;

b) one member representing the Ethiopian Employers Federation,

c) representatives of other appropriate bodies.

2/ The Director GeneraI of the Agency shall participate in Board meetings with no voting righI.

.

3/ The members of the Board shall be paid service fees detelInined by the govemment.

. fnç.,. .l'',:V'l'}5 1'''Il1ç 9. Powers and Duties of the Board

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The Board shall have the powers and duties to:

II oversee and supervise activities ofthe Agency;

21 submit the organizational structure and salary

•

scale of the Agency to the Ministry to secure approvaI ofthe govemment;

31 approve the recruitment, placement and the dismissal of officers accountable to

Directors ofthe Agency; ,

41 examine and approve the Agency's strategies and implementation guidelines and monitor and supervise their implementation;

51 submit the annual work plans and budgets of the Agency to the Ministry to secure approvaI of the govemment, and ensure the implementation of same;

61 approve the annual operational and fmancial reports of the Agency; appoint extemal auditors, ensure that adeguate measures are taken in accordance with audit reports, and ensu~e that audit reports are made public;

71 approve income generating activities including investments;

81 advise the Ministry on relevant matters related to health insurance;

91 issue directives on matters that come within

the powers and duties ofthe Agency. •

. . . ...., . . .... .

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u.) Mh.:~:')(t.m- l' /"'t· ?,').pÌl.4'r\ 1''''1:/ • • ...... u ... ,Ol ... "

l/ The Board shall me et once 111 a quaner ; provided, however, that extraordinary meetings of the Board may be held at any time at the cali of the Chairperson or one·third of the Board members.

2/

31

There shall be quorum where more than half of the members are present at a meeting of the Board.

Decisions of the Board shall be passed by a majority vote of the members present; in case of a ti e, the Chairperson sha ll have a casting vote.

41 Without prejudice to the provisions of this Artic1e, the Board may adopt its own rules of procedures.

11. Term or Board Membership

I l The term of a Board membership shall be for

five years; provided, however, that membership

may be extended for only one additional term.

2/ Any Board member wishing to end his

membership of the Board prior to the expiry of

hi s term shall notify the Board.

31 Notwithstanding the provisions of sub·artic1e

(I) of this Artic1e, when the term of the Board

member expires, the Chairperson of the existing

Board shall serve as a member in the incoming

Board for a period not extending six months.

12. Powers and Duties or the Director Genera/

I l The Director Generai shall be the chief executive officer of the Agency and shall, under

the overall guidance of the Board, direct and administer the activities ofthe Agency.

2/ Without prejudice to the generality of sub· articJe (I) of this ArticJe, the Director Generai shall:

a) exercise the powers and duties of the

Agency specified in ArticJe 6 of this

Regulation:

b) employ and admi ni ster employees of the Agency in accordance with the basic principles ofthe federai civil service laws;

c) prepare and submit to the Board the annual

work plans and budgets of the Agency and

implement same upon approvai;

d) prepare and submit to the Board draft directives and implement the same up on approvai ;

e) submit reports of the Agency to the

Ministry upon their approvai by the Board;

,

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3/ The Director Generai may delegate part 01 hls powers and duties to the employees of the Agency to the extent necessary for the efficient perfOI mance of its activities.

13. Powers and duties of Deputy Director Generals

11 Deputy Director Generals shall:

14.

a) assist the Director Generai in planning,

directing and coordinating the activities of

the Agency;

b) perfOIII1 other activities assigned to them

by the Director GeneraI.

21 The Deputy Director Generai who is specifically

delegated shall act on behalf of the Director

Generai in his absence.

11 The budget required to cover staff remunerations and administrative costs of Agency shall be allocated by the federai government.

21 The Agency shall cover service costs from sources provided under Article 6 of the Proclamation .

31 The Agency may not be held liable beyond its total assets.

15. Bank Accounts

The Agency shall open and operate bank accounts in its name.

16. Disbursement

17.

.

Disbursement shall only be made in accordance with the approved annual work plans of the Agency and directives of the Board.

11 The Agency shall keep complete and accurate books of accounts of the funds of the health •

insurance system.

21 The books of accounts and other financial documents of the Agency shall be audited annually by the Auditor Generai or by auditors appointed by him.

31 Audited financial reports shall be submitted to the Board within four months following the end of the fiscal year.

18. Inapplicable Laws

No regulations, directives or practices shall, in so far as they are inconsistent with this Regulation, be applicable in respect of matters provided for by this Regulation.