Public Health Insurance
Long-term Contractual Health Insurance
Short-term Contractual Health Insurance
Free Provision of Healthcare on the Basis of International Agreements
Questions and answers concerned with The Extent of Health Insurance Cover

The Extent of Health Insurance Cover Public Health Insurance

 

Care Fully Covered by Health Insurance:

Healthcare provided on the basis of public health insurance and covered by this insurance includes:

·        outpatient and inpatient (hospital) medical care,

·        accident and emergency services,

·        preventative care,

·        dispensary care,

·        provision of medicaments and medical technical means (e.g. equipment used during diagnosis, but also medical and auxiliary equipment, e.g. aids for the hard-of-hearing, medical dressing etc.) and dental products,

·        spa care, care in specialist paediatric medical facilities and sanatoria,

·        company preventative care,

·        transport of the sick, payment of travel costs,

·        review activities (only to certain limits),

·        examination of the dead and post morta.

 

Individual medical procedures by doctors who have contracts with the health insurers, either in outpatient or inpatient services, are fully covered by these insurers, and doctors under contract with insurers are not authorised by them to request any charges from insured patients. However, if the patient is not insured the doctor is required to request payment for medical procedures regardless of whether they have concluded insurance contracts themselves or not.

 

Healthcare with Financial Contributions by the Patient:

 

Policy-holders share in part in the payment of a number of procedures as well as medical technical resources in the framework defined by law. This concerns, for example, dental procedures, part of spa care and some medicaments. Some medicaments are fully covered while patients contribute to some others. At the same time there must be at least one medicament from each group which is fully covered; for the others the doctor must inform the patient beforehand of the requirement to pay a charge on receipt.

 

Costs for medicaments and medical technical resources in the course of hospital treatment are fully covered.

 

Healthcare Fully Covered by the Patient:

Healthcare which is not included in public health insurance and which it is necessary to pay for directly is limited by law. This concerns, for example, plastic surgery, selected dental procedures or acupuncture.

In addition public health insurance does not cover some procedures and examinations, carried out in the personal interest of the policy-holder or other persons, which do not have a directly medical character and whose purpose is not the maintenance and improvement of the health of the policy-holder. This concerns, e.g., examinations for issuing driving licences, examinations at the start of employment, confirmation of state of health for studying and so on.

 

Long-term Contractual Health Insurance

Long-term contractual health insurance covers care which is:

·        diagnostic,

·        treatment,

·        outpatient,

·        hospital,

·        costs covering medicaments and medical technical resources (to the same extent as for persons insured on the basis of public health insurance, with the exception of hearing aids, electric wheelchairs and myoelectrical prostheses),

·        expenditure connected with transport to healthcare facilities.

 

The extent of healthcare covered on the basis of long-term contractual health insurance is set out by the VZP General Insurance Conditions, which include a list of types of care not covered by contractual insurance. This concerns company preventative care, institutional care in specialist medical institutions, spa care, dental care (with the exception of injury), transplantation, treatment of alcohol and drug dependence (including all complications and related diagnoses), treatment of AIDS, care of diabetes treated with insulin, treatment of chronic kidney failure by haemodialysis, treatment by growth hormones, treatment of haemophilia and other failures of blood coagulation, treatment of hereditary defects, treatment of infertility, treatment of speech defects. Furthermore, care provided outside the framework of public health insurance, like examinations, check-ups and other medical procedures in the personal interest of the policy-holder, which do not have a medical purpose (cosmetic health procedures, abortions, drawing up of health reports at the request of physical persons).

 

Company preventative care is not covered by contractual health insurance; the costs of examination are covered by the employer. If the person is self-employed he or she pays the costs alone.

 

Short-term Contractual Health Insurance

The extent of healthcare covered on the basis of short-term contractual health insurance is given by General Insurance Conditions and the contract provisions.

This insurance covers:

·        payment of costs of necessary and urgent treatment in the CR and transit countries on the way to the CR,

·        costs for acute dental examination up to 5000 CZK,

·        costs for the repatriation of the policy-holder to country of origin,

·        costs for transport of bodily remains to the country of origin in the case of the death of the policy-holder.

 

Free Provision of Healthcare on the Basis of International Agreements

 

In the territory of the Czech Republic healthcare (outside the framework of public health insurance) is provided to foreign nationals on the basis of international agreements, concluded between the Czech Republic and their home country.

 

This particularly concerns agreements on the free provision of necessary and urgent healthcare in the territory of the CR. In order to receive healthcare on the basis of these agreements, the person just shows his or her passport to prove the citizenship of the given state. This healthcare provision is covered by the Czech Ministry of Health.

 

The CR has concluded bilateral agreements authorising the free provision of urgent healthcare to citizens of the following countries:

Afghanistan, Bosnia and Herzegovina, Bulgaria, Iraq, Yemen, the Republic of Macedonia, Cambodia, Cuba, Cyprus, Libya, Hungary, Morocco, Mozambique, Poland, states of the former USSR: Armenia, Azerbaidzhan, Georgia, Kirghizstan, Moldavia, Tajikistan, Greece, Slovenia, Sudan, Syria, Tunisia, Great Britain, Vietnam.

 

In the case of Vietnam and Tunisia free healthcare applies only to persons sent into the territory of the second state in the framework of co-operation established by these agreements. In practice this means that, from the 4th July 2001 in relation to Vietnam and 5th December 2001 in relation to Tunisia, neither tourists of the mentioned states nor long-term resident foreign nationals can, on the basis of this agreement, be provided with free healthcare. Such must take out health insurance in the CR or pay for healthcare in cash.

 

A second type of agreement are the new agreements on social security, a component of which is the provision of healthcare. These are based on the transfer of rights to health insurance on the territory of the other contractual state. Certain administrative procedures are necessary for claiming entitlement. Care provided on the basis of these agreements is generally limited to necessary and urgent care. However, if authorised by the relevant health insurer, it can be provided to a greater extent.

 

Currently these agreements are in force: from 1.7.2001 with Austria, from 26.4.2002 with Croatia, from 1.3.2002 with Luxembourg, from 1.9.2002 with Germany, from 1.12.2002 with the Federal Republic of Yugoslavia (Serbia and Montenegro) and soon other agreements will be added. Since 1.7.2002 an agreement has been in force with Israel, healthcare provision concerns unexpected (premature) birth, necessary and urgent care in the event of work-related illness and injury. On 1.4.2001 an agreement came into force with the Slovak Republic arranging the provision of acute and necessary healthcare from public health insurance.

 

The exact arrangements of conditions under which care is provided - in what way and in which cases - are laid out in the administrative arrangements which form part of these agreements. These conditions can differ in individual agreements. Therefore all persons travelling to the CR should demand information from the relevant authorities as to whether they meet the conditions set in the international agreements.

 

A list of valid international agreements, including social security agreements, is accessible at the Ministry of Health's website: www.mzcr.cz international relations, bilateral agreements. This list is regularly updated. The relevant articles concerning the provision of healthcare are also given there. At this site it is also possible to find further information to help people to orientate themselves with the mentioned agreements.

 

Questions and answers concerned with The Extent of Health Insurance Cover

 

How do I know the doctor is not using the fact that I am a foreign national and asking me to pay too much in cash? How can I protect myself?

 

If you are insured in the framework of public health insurance it is not allowed (except where stipulated by law) to request direct payment from you for care provided.

If you are contractually insured you have the right to free healthcare in line with the General Insurance Conditions. Generally healthcare is provided free of charge.

If you visit a medical facility and they request immediate payment for care covered by your insurance you have the right to refuse payment. You should also contact the assistance services. If you have already paid something request a receipt of payment where the procedure performed is described.

The justification of collecting direct payment for care provided can be verified by your insurer (if you are insured by VZP ČR from their assistance services) and in the case that a payment was unjustifiably demanded, you can claim a refund payment at your health insurer. Make payment only after the care has been provided.

If you do not have health insurance it is necessary to agree terms in advance with the medical facility which is treating you. Each medical facility has its own prices for individual medical procedures.

 

How do I pay for care which is not covered by health insurance?

 

Care which is not covered by public health or contractual health insurance must be paid directly.

 

How are medicaments paid for? What if a pharmacist wants payment for medicaments on prescription?

 

If you are insured on the basis of public health insurance you have the right to the provision of medicaments. It is quite normal that some medicaments require a charge in cash which is non-returnable. The legitimacy of charges can be established in the pharmacy itself (or at the doctor's surgery) in the Price Tariff of Medicaments.

If you are insured on the basis of long-term contractual health insurance you have the right to medicaments and medical technical resources to the same extent as persons insured on the basis of public health insurance, with the exception of hearing aids, electric wheelchairs and myoelectrical prostheses. Please note that, on the basis of the VZP General Insurance Conditions for long-term contractual health insurance, you are required to pay for prescribed medicaments in cash. On submission of payment receipts (prescription receipts confirmed by the pharmacist on the issue of medicaments), you have the right to a refund of costs at any VZP branch.

For short-term contractual insurance medicaments prescribed during outpatient care are not covered by insurance. Medicaments provided during hospitalisation are part of the costs of hospitalisation and are covered by the insurer.

 

How are ambulance services paid for?

Intervention by ambulance services is, in this case, considered as urgent healthcare and covered by insurance.

 

What are the charges for a dentist? Do I have to pay for everything at the dentist's or is something covered by insurance?

If you have public health insurance, dental care will be provided free of charge to the extent established by law (concerning just basic care). You can, however, select procedures not covered by insurance, for which you will either pay in part or in full. The physician is required to inform you in advance about possible charges.

If you are a policy-holder of contractual insurance a different situation applies. For short-term contractual insurance only acute dental care up to 5000 CZK is covered.

For long-term contractual insurance only treatment of injuries is covered. You can, however, take out abovestandard insurance for acute dental care up to 5000 CZK.

Dental care not covered by premiums is covered by the patient.