Armenia clarifies payment procedures for children's treatment under the universal health insurance system
09.09.2026,
10:45
Having universal health insurance does not automatically mean coverage for every medical service for a child.
YEREVAN, September 9. /ARKA/. Having universal health insurance does not automatically mean coverage for every medical service for a child. When receiving scheduled specialized care, it is necessary to follow the established procedure, according to clarifications from Armenian Health Minister Anahit Avanesyan.
In particular, the cost of a scheduled consultation may not be reimbursed if the patient goes directly to the hospital, bypassing the established referral procedure. In certain cases, a specialist consultation may also require co-payment.
To receive a scheduled specialized consultation under the general insurance package, you must first contact your primary healthcare provider—a clinic or outpatient clinic.
For a child, the first step is to contact a pediatrician or other primary care physician. If necessary, the primary care physician will issue a referral to a specialist or medical center.
For scheduled specialized consultations, as well as laboratory and instrumental tests, a referral is issued electronically through the ArMed system.
However, the law provides for cases where certain types of medical care can be sought directly, without a referral from a primary care physician.
If a patient goes directly to a hospital for a scheduled consultation for which a referral is required, insurance may not cover the costs. According to Avanesyan, if the established procedure is not followed, the costs of such a consultation are not covered by insurance.
This rule does not apply to emergency care. In urgent cases, a person can seek hospital medical care directly, and in life-threatening conditions, identification of the insured person may be conducted after emergency care has been provided.
In certain cases, a consultation with a specific specialist may require a co-payment. However, the minister did not specify specific specialties or co-payment amounts.
Insurance only covers medical services included in the established insurance package. It includes primary care, emergency care, outpatient, and inpatient medical services to the extent stipulated by law.
Information on the insurance package, co-payments, and the procedure for receiving services can be found on the official resources of the universal health insurance system—unif.am and moh.am—or by calling the Fund's call center at 8866.
Minors under 18 have been included in the universal health insurance system since 2026. The state covers the costs of their insurance.
However, having insurance does not change the established procedure for receiving scheduled medical care: for some specialized services, prior contact with a primary care provider and an electronic referral are required.
In particular, the cost of a scheduled consultation may not be reimbursed if the patient goes directly to the hospital, bypassing the established referral procedure. In certain cases, a specialist consultation may also require co-payment.
To receive a scheduled specialized consultation under the general insurance package, you must first contact your primary healthcare provider—a clinic or outpatient clinic.
For a child, the first step is to contact a pediatrician or other primary care physician. If necessary, the primary care physician will issue a referral to a specialist or medical center.
For scheduled specialized consultations, as well as laboratory and instrumental tests, a referral is issued electronically through the ArMed system.
However, the law provides for cases where certain types of medical care can be sought directly, without a referral from a primary care physician.
If a patient goes directly to a hospital for a scheduled consultation for which a referral is required, insurance may not cover the costs. According to Avanesyan, if the established procedure is not followed, the costs of such a consultation are not covered by insurance.
This rule does not apply to emergency care. In urgent cases, a person can seek hospital medical care directly, and in life-threatening conditions, identification of the insured person may be conducted after emergency care has been provided.
In certain cases, a consultation with a specific specialist may require a co-payment. However, the minister did not specify specific specialties or co-payment amounts.
Insurance only covers medical services included in the established insurance package. It includes primary care, emergency care, outpatient, and inpatient medical services to the extent stipulated by law.
Information on the insurance package, co-payments, and the procedure for receiving services can be found on the official resources of the universal health insurance system—unif.am and moh.am—or by calling the Fund's call center at 8866.
Minors under 18 have been included in the universal health insurance system since 2026. The state covers the costs of their insurance.
However, having insurance does not change the established procedure for receiving scheduled medical care: for some specialized services, prior contact with a primary care provider and an electronic referral are required.
