The Green Card is a social assistance program that allows citizens who are not covered by social security in Türkiye and who do not have the means to pay to benefit from health services with state support. The system, which was put into practice with the Law No. 3816 on the State Coverage of Treatment Expenses of Citizens Who Do Not Have the Power to Pay by Granting a Green Card dated June 18, 1992, covers the inpatient and outpatient treatment expenses of low-income individuals. The regulation dated August 13, 1992, regulates the application processes, income assessment, and provision of health services. The Green Card aims to facilitate access to health services for Turkish citizens who do not have social security.

Purpose and Scope of the System

The Green Card aims to cover the treatment expenses of Turkish citizens who cannot receive health assistance from social security institutions. It covers individuals residing in Türkiye and whose household income share is lower than a certain percentage of the minimum wage. The regulation regulates all processes from income calculation to the provision of health services and includes the following services:

• Inpatient treatment services and expenses in inpatient treatment institutions.
• Examination, examination, analysis, dressing, tooth extraction, dental prosthesis, glasses, and medicine expenses within the scope of outpatient treatment in primary, secondary, and tertiary health facilities.
• Treatment expenses of newborn babies (not exceeding 90 days) and patients requiring emergency treatment.
• Those receiving health assistance from social security institutions, those under arms, non-Turkish citizens, and treatments received abroad are excluded from the scope.

Application Process and Required Documents

Those who want to benefit from the Green Card apply to the governor's office or the district governor's office according to their place of residence. Applications are made with the standard Green Card Application and Information Form. Applicants from the same household use a single form, and all household members, including those who do not apply, are specified on the form. Legal representatives apply for individuals under guardianship or tutelage. Applications of adults are signed separately and included on the form.

The application form includes the following information:

• The applicant's name, surname, address, signature, and application date.
• Information on individuals under guardianship or tutelage.
• Household notification, social security status, and income-financial status declaration.
• Commitment regarding the accuracy of the declarations and penal consequences of false declarations (double refund as per Article 10 of the Law).
• Certifications of institutions such as the Mukhtar's (Head of neighborhood) office, the population directorate, land registry office.
• Board decision and Green Card delivery information.
• Applications are recorded in the Green Card Application Registry, and a single transaction file is opened for the same household. New applications are combined with the existing file. The governor's office or the district governor's office keeps records for the orderly conduct of the transactions.

Evaluation of Applications

Applications are evaluated by provincial or district administrative boards at least once a month. The income status of the household is verified by the mukhtar's office, population directorate, treasury, land registry office, and other institutions. Income calculation is made by dividing 1/12 of the annual net income of the household (wage, agricultural income, rent, interest, grant, etc.) by the number of household members. The income of those with Social Security is also taken into account. If the household income share is less than 1/3 of the net income of a taxpayer whose spouse is not working, married, and has one child, the Green Card is issued.

The boards may request additional information from social security institutions, banks, cooperatives, or mukhtar's offices. Verification procedures are completed within 15 working days from the application. A reasoned decision is notified to those who are not deemed appropriate to be granted a Green Card.

Provision of Health Services and Referral Chain

Green Card holders can apply to primary, secondary, and tertiary healthcare facilities in their place of residence:

• Primary care (health centers, tuberculosis dispensaries): Direct referral.
• Secondary care (state hospitals): Referral from primary care or directly.
• Tertiary care (training and research hospitals): Referral from primary or secondary care or directly.

In emergency cases, the referral chain is not required, but the emergency must be approved by the authorized physician. Chronic patients and call recipients can apply to the hospital where they are receiving treatment without a new referral. Referral to private health facilities is only made if there is no suitable treatment or intensive care bed in secondary and tertiary care facilities.

Health services are billed according to the Social Security Institution (SGK) Health Implementation Circular. In inpatient treatments, medical supplies and medications are covered by the health facility. In outpatient treatment, prescription medications are obtained from pharmacies contracted with the SGK. Eyeglass and dental treatments are provided according to the relevant regulations and circular principles.

Payment and Registration Procedures

The fees for services provided to Green Card holders are paid in accordance with the SGK circulars. The fees for services outside the scope or applications that do not comply with the referral chain are not paid.

Those who are given a Green Card are reported to the population directorates, and changes such as death, marriage, and divorce are reported to the governor's office or the district governor's office. The Green Card is valid for one year and requires a visa procedure every year. Cards that are not visaed are deleted from the population records.

In the event that the Green Card becomes invalid (social security provision or income increase), the card is returned. If a false statement is detected, the paid fees are collected double and criminal prosecution is initiated.

Coordination with the Social Assistance and Solidarity Foundation

Green Card decisions are notified to the Social Assistance and Solidarity Foundation in accordance with Article 11 of Law No. 3816. The Foundation carries out the procedure for the payment of the fees for health services outside the scope. Changes in income and financial status of Green Card holders are communicated to the foundation by the muhtars' offices or other institutions.