Insured workers and retirees covered by the Social Security Institution (SGK) are entitled to a range of healthcare services. Likewise, people who are not employed under SGK, and those who do not receive survivor or orphan pensions, can still obtain coverage under SGK provided their general health insurance premiums are paid. The same rules apply to persons with disabilities.
Healthcare for Those Without Income or Coverage
Individuals who are unemployed and not insured must enroll in general health insurance and pay premiums regularly to access healthcare services provided by public hospitals. To determine eligibility for state support, uninsured persons must apply to the Social Assistance and Solidarity Foundations in their area and undergo an income test. The income test divides the total monthly household income by the number of people living in the household to calculate a per-person monthly income.
Accordingly;
- Those whose per-person monthly income is less than one-third of the gross minimum wage have their health insurance premiums paid by the state. This arrangement resembles the previous green card scheme and is commonly referred to as G0 status.
- Individuals whose per-person monthly income exceeds the gross minimum wage must pay a monthly health insurance premium. For those above the threshold, paying this premium is mandatory. If premiums are not paid, SGK will demand the unpaid amounts with interest for each overdue month.
People who do not pay their premiums appear in hospital records as indebted and must cover the costs of any treatments, tests, and procedures. Similarly, household members over 18 must pay their premiums if they are not in education. However, those who have finished high school remain eligible for health coverage under their parents for two years; the same two-year extension applies to university graduates.
Health Insurance Premiums for Persons with Disabilities
The same rules apply to health coverage for persons with disabilities. If a disabled person receives a disability pension, the state pays their health insurance premium and covers their healthcare expenses. When a disability pension begins, any prior coverage the disabled person had under a parent ends and the state assumes the premium payments.
Unless a special arrangement exists, disability pension recipients cannot go directly to university hospitals for treatment. These patients must first obtain a referral from their family physician or a public hospital before being admitted to a university hospital.
Health Coverage for Disabled Children
A disabled daughter whose disability pension has been stopped may be able to return to her parents’ health coverage. Male disabled children who reach the age of 18 can continue to receive health benefits under their parents by obtaining a disability card (malul kartı) from SGK; in such cases they may also qualify for orphan’s pension rights. Those who cannot obtain the disability card must pay monthly general health insurance premiums. Parents of disabled children under 18 receive a caregiver relative allowance and are classified as dependents of the disabled person; as a result, they do not pay health insurance premiums. Once their child turns 18 and the caregiver allowance ends, those parents must begin paying health insurance premiums themselves.
For persons with disabilities and for all beneficiaries under the health insurance system, SGK covers the costs of examinations, treatments, medications, and medically necessary devices and supplies. The extent of cost coverage varies depending on the type of treatment and the clinical procedures required during the course of care.