MINISTRY OF HEALTH APPLICATION FOR MEDICAL CARD (To be submitted to the nearest Hospital or Health Centre)

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MINISTRY OF HEALTH APPLICATION FOR MEDICAL CARD (To be submitted to the nearest Hospital or Health Centre) WARNING: Any person who, with a view to obtaining a medical card, either for himself or for any other person, knowingly or by gross negligence, makes a false statement or false representation or presents or produces any document or item of information, which is false in any material fact, shall be guilty of an offence and shall be liable to a fine not exceeding one thousand pounds or to a period of imprisonment not exceeding six months, or to both these penalties. Applications not accompanied by the necessary documents shall not be accepted and shall be rejected. Before completing this application read the INSTRUCTIONS carefully EXPLANATORY NOTES 1. As a rule Medical Identity Cards are issued to citizens of the Cyprus Republic, who are permanent residents of Cyprus. 2. Medical Card A (free medical care) is issued to the following persons: (a) Persons without dependants whose annual income does not exceed 9000. (b) (c) (d) (e) (f) Members of families whose annual income does not exceed 18.000, increased by 1000 for each dependant child. Members of families with four or more children. Enclaved persons and members of their families. Dependants of missing persons. Individuals and members of families receiving public assistance. 3. Medical Card B (treatment at reduced fees) is issued to the following persons: (a) Persons without dependants whose annual income exceeds 9.000 but not 12.000 (b) Members of families whose annual income exceeds the amount stated in paragraph 2 (b) above, but does not exceed the amount of 22.000, increased by 1000 for each dependant child. 4. «Income» means the gross income (that is before deduction of any tax or contribution) from any remuneration, salary or wages, any profit from trade or profession, from immovable property from interest, dividends or other sources, other than public assistance, child benefit and student grant. 5. «Dependant» means the spouse and unmarried children under the age of eighteen.

INSTRUCTIONS 1. Parts Ι and ΙΙ of the application must be completed by ALL applicants. Parts ΙΙΙΑ and Β ARE NOT TO BE COMPLETED by heads families with four or more children, (unless they are pensioners), members of enclaved families and the dependants of missing persons.. 2. Where there is a mark with a the appropriate answer in each case. 3. For all children aged 12 and over the identity card number must be entered. 4. For children who are in employment the Social Insurance number must be entered. 5. For persons aged 18 and over the electoral book number must be entered. 6. In Part ΙΙΙ enter the income of the applicant, his/her spouse, as well as the income of dependant children who receive income from work or other sources. 7. Pensions are declared in Part ΙΙΙΒ separately for each member of the family who receives a pension from any source. 8. Pensioners must declare in Part ΙΙΙΑ their last occupation prior to retirement. 9. Required supporting documents (the documents accompanying the application are to be indicated with an «Χ»): a) For large families with four or more children: Photocopy of a large family identity card or Certificate from another competent authority. b) For the dependants of missing persons and members of enclaved families: Certificate from the competent authority. c) For certification of income :- Certificate from the employer for current monthly/weekly gross income. (for employees and pensioners who continue to work as employees). Copy of receipt of payment of Social Insurance contributions for the last quarter (for the self-employed and for pensioners who continue to work as self-employed). Certification of gross monthly pension for pensioners from the Dept. of Social Insurance and from their Pension Fund if they also receive a pension from their employer or other source. Copy of the last notice of payment of income tax. Copy of the last tax return form. Copy of insurance record and certificate of unemployment from the Dept. of Social Insurance (for the unemployed). d) Other certificates Medical certificate (if the applicant suffers from a chronic disease for which income criteria do not apply). Certificate of divorce for divorced persons. Certificate of receipt of public assistance (for those receiving benefits from the Department of Social Welfare Services). Registration certificate for applicants who are full students.

Created on 3/21/2003 7:55 AM 11:3510/09/03 GENERAL REGULATIONS The provision of health care services by the Government Medical Services is governed by the Government Medical Institutions and Services General Regulations of 2000 and 2002. Coverage The Regulations distinguish the persons who use the Government Medical Services into the following categories: 1.1.1 Persons to whom services are provided free-of-charge 1.1.1.1 The President of the Republic, the members of the Council of Ministers, the members of the House of Representatives. 1.1.1.2 Active and retired civil servants, members of the educational service, of the police force and the armed forces. 1.1.1.3 The dependants of (i) and (ii) above. 1.1.1.4 Members of families with 4 or more children. 1.1.1.5 Students of the University of Cyprus and certain other state educational institutions. 1.1.1.6 War pensioners. 1.1.1.7 Persons in receipt of public assistance. 1.1.1.8 Certain categories of chronically ill. 1.1.1.9 Single persons whose annual income does not exceed 6.000 and members of families whose annual income does not exceed 10.000 increased by 600 for each dependent child. 1.1.2 Persons to whom services are provided at reduced fees 1.1.2.1 Single persons whose annual income is between 6.001 and 12.000. 1.1.2.2 Members of families whose annual income is between 18.001 and 22.000 increased by 1000 for each dependent child. 1.1.3 Paying Patients Persons not coming under categories (a) and (b) can make use of the Government medical services against payment of the fees prescribed from time to time. 1.1.4 Health Services Provided 1.1.4.1 Out-patient care by general practitioners and specialists care to both out-patients and inpatients. 1.1.4.2 The necessary drugs and pharmaceutical material. 1.1.4.3 Diagnostic and paramedical examinations. 1.1.4.4 Hospitalization. 1.1.4.5 Dental care, except for dentures, which are provided to certain low-income groups. 1.1.4.6 Medical rehabilitation and provision of prosthetic and orthopedic appliances. 1.1.4.7 Domiciliary visiting, in exceptional cases (for saving life or averting serious disability). 1.1.4.8 Transport of the patient, as his condition requires.

1.1.5 Fees 1.1.5.1 Out-patients Paying patients pay 10 for a visit to a specialist and 7 for a visit to a general practitioner. In addition they pay the fees prescribed for laboratory, radiology and all examinations and tests. 1.1.6 In-patients In-patient fees for paying patients are as follows: 1.1.6.1 For accommodation and nursing: 60, 50 and 35, for 1 st class, 2 nd class and 3 rd class ward, respectively and for intensive care 100,daily. 1.1.6.2 For medical attendance: 10 daily. 1.1.6.3 For drugs, curative material, laboratory and radiology tests and any other services: the corresponding prescribed fees. Co-payments by persons entitled to free medical care: 1.1.6.4 Persons entitled to free medical care pay 1.00 per outpatient visit, except pensioners whose pension is up to 300 per month and public assistants recipients. 1.1.6.5 Persons entitled to free care by reason of status (state officials, civil servants etc) pay for each day of in-patient treatment 10, 5 and 3 for stay in 1 st class, 2 nd class and 3 rd class ward, respectively. Co-payments by person entitled to care at reduced fees: 1.1.6.6 Persons entitled to medical care at reduced fees pay 50% of the fees payable by paying patients. Reduction of in-patient care fees for paying patients: 1.1.6.7 Apart from the categories entitled to free-of-charge or at reduced rates care, paying patients may have the fees for in-patient treatment reduced, taking into account the level of their income. 1.1.6.8 Recovery of fees from third parties The right to free medical care is waived in case the person concerned has been treated for a condition caused under circumstances creating a legal liability for damages, by a third person (e.g. injuries caused by traffic accidents). In such cases the fees will be claimed from the person liable for the damages. 1.1.6.9 Procedure for determining eligibility to free-of-charge or at reduced fees care Every person wishing to benefit from the provisions of the Regulations has to make an income declaration supported by evidence such as a contribution certificate from the Social Insurance Department, salary advice from the employer, taxation notification and any other relevant document. 2

1.1.7 MAIN PROVISIONS OF GOVERNMENT MEDICAL INSTITUTIONS AND SERVICES GENERAL REGULATIONS OF 2000 1.1.7.1 CATEGORIES OF PERSONS WHO USE THE GOVERNMENT MEDICAL SERVICES:- 1. Persons to whom services are provided free-of-charge (a) Single Person Annual Income does not exceed 9.000 (b) Members of families Annual Income does not exceed 18.000 + 1000 for each dependent child (c) Members of families with 4 or more children Irrespective of income (d) Cypriot citizen living in occupied areas and members of their families Irrespective of income 2. Persons to whom services are provided at reduced fees (a) Single Person Annual Income is between 9.001 and 12.000 (b) Members of families Annual Income is between 18.001 and 22.000 + 1000 for each dependent child 3. Paying Patients Persons not coming under categories (1) and (2) 3

1.1.7.2 BILLING OF IN-PATIENTS 1. Persons to whom services are provided free-ofcharge 2. Persons to whom services are provided at reduced fees Free-of-charge Pay 50% of the fees payable by paying patients subject to a maximum according to income. 3. Paying Patients Pay the fees prescribed by the regulations Paying patients (categories (1) and (2)) may have their fees for in-patient treatment reduced taking into account the level of their income (see table III) 4. Civil servants and other persons entitled to free care by reason of status 10 per day for stay in 1 st class ward 5 per day for stay in 2 nd class ward 3 per day for stay in 3 rd class ward 4

1.1.7.3 REDUCTION OF IN-PATIENT FEES FOR PAYING PATIENTS Annual Income % Charge on annual Income Maximum Charge 0-9.000 0 0 9.001-15.000 20% 1200 Single persons 15.001-20.000 25% 1200+1250 20.001-30% 2.450 + 30% of Annual Income-in excess of 20.000 0-18.000* 0 0 18.001*-20.000 20% 400 20.001*-25.000 25% 400+1250 Members of families 25.001-30% 1650 + 30% of Annual Income-in excess of 25.000) * The amount is increased by 1000 for each dependent child 5