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System of public health insurance Extent of medical care covered by health insurance companies Medical care covered by health insurance companies: Healthcare provided within the system of public health insurance and covered by the funds of this insurance system includes: out-patient and (hospital) care, emergency and rescue service, preventive care, dispensary care, provision of pharmaceuticals, medical devices and instruments (e.g. diagnostic instruments, but also therapeutic and medical supplies, e.g. hearing aids for the deaf, bandages etc.) and dental products, spa cure, care in specialized sanatoria and health resorts for children, medical preventive care, transportation of patients, reimbursement of travel expenses, assessment physician service (to a certain extent only), examination of a deceased and the autopsy. Medical procedures provided by physicians who have signed a contract with one of health insurance companies -be it out-patient services or hospital treatment- are fully covered by these insurance companies; physicians with such contracts are not entitled to require any fees from insured patients. However, if a patient has no health insurance, doctor is obliged to require the payment for medical service provided irrespective of the fact, whether he/she concluded a contract with one of the insurance companies or not. Health care co-financed by the patient: Insured persons co-finance some medical procedures and also medical supplies or instruments the price of which exceeds the level defined by law. These include e.g. some dental procedures, a portion of spa cure and especially payment of some pharmaceuticals. The price of some pharmaceuticals is fully covered by insurance companies, other pharmaceuticals are co-financed by patients. Every category of pharmaceuticals must include at least one which is fully covered by insurance companies; as regards the others, physician shall advise a patient in advance that he/she will be paying certain amount, when collecting a pharmaceutical in a pharmacy. Pharmaceuticals and medical supplies (devices) provided in the course of hospital treatment are fully covered by insurance companies. Medical care covered by patients Medical and health care which is not covered by the system of public health insurance and which must be paid directly is defined by law. Such care includes e.g. plastic surgeries, selected dental procedures or acupuncture. Funds of the public health insurance system are not used to cover some procedures and medical examinations carried out in the personal interest of the insured or of other person. These are procedures which do not have a direct curative effect and which do not aim at preserving or improving the state of health of the insured. These procedures include e.g. medical check up for the issuance of a driving license, 1 medical examinations required by an employer to employ a person, certificate on one’s health fitness for studying etc. Contractual health insurance Aliens who do not meet the conditions of the public health insurance system can effect a contractual insurance. Long term contract on health insurance This type of insurance can be underwritten by aliens who are staying in the CR based on a visa valid for more than 90 days or a visa for a long term stay. Of course only in case that they are not included in the system of public health insurance (i.e. they are not employed by a Czech employer). The level of benefit payment in case of an insurance event can reach a maximum limit of an insurance contract for CZK 1 000 000. This necessarily contains an accident insurance, which includes: insurance for the case of death due to an accident, insurance of permanent consequences of an accident, period of necessary cure of accident consequences. Detailed information about accident insurance can be found on the website of Hasičská vzájemná pojišťovna. Funds of a long term contractual health insurance are used to cover the following types of care: diagnostic, medical, out-patient, hospital,l costs of pharmaceuticals and medical supplies (the coverage is at the same level as in case of persons included in the system of public health insurance with the exception of hearing aids, electric wheelchairs and myo-electric prosthodontics), costs relating to transportation of a person to a health care facility. Extent of health care covered by a long term health insurance contract is defined by General Insurance Terms and Conditions of the Universal Health Insurance Company (VZP), which include a list of types of care not covered by a long term contractual health insurance. Health insurance of aliens covering comprehensive care is effected for the period of 6 to 12 months, it is paid in Czech Crowns in advance for the whole period insured. Terms and conditions under which contractual insurance is effected, the extent of insurance benefit and the rights and obligations of the ensured and the insurer, as well as the method of premium payment are defined by the General Terms and Conditions of insurance issued by the VZP. 2 Health insurance of aliens covering comprehensive care – see the website of VZP. Note! If an alien is granted permanent stay in the CR or if he/she finds a job with a Czech employer (thus being included in the system of public health insurance), he/she is obliged to report this fact to the insurance company because the company is not obliged to examine, whether the premium has not been paid twice - i.e. based on the insurance contract and also based on the law on public health insurance. The fact that the insured has been included in the public health insurance system does not automatically result in the termination of insurance contract and in itself is not the reason for returning a portion of the premium. In such case insurance can be terminated by the agreement of contractual parties only. Short term contract on health insurance Health insurance of aliens covering emergency care The extent of health care covered by a premium of a short term contractual health insurance is defined by General Terms and Conditions of Insurance and by an insurance contract. This type of insurance is appropriate for aliens who are staying in the CR for a period of time shorter than 365 days, e.g. as tourists or temporary employees. Insurance contract can be signed as a standard health insurance contract, extended health insurance contract or health insurance contract of athletes who take part at competitions or who engage in hazardous sports. This type of insurance covers: costs of necessary and emergency treatment in the CR and transit countries on the way to the CR, costs of acute dental treatment up to he limit of one insurance event, costs o repatriation of the insured to his/her home country, costs of transportation of the body of the insured to his/her home country in the case of his/her death. More details on Health insurance of aliens covering emergency care – see the website of VZP . Мedical care provided for free on the basis of international agreements Aliens in the territory of the CR are also provided with health care (outside the system of public health insurance) on the basis of international agreements concluded between the Czech Republic and their respective home country. These are primarily agreements on the provision of necessary and emergency medical care in the territory of the CR. To be provided medical care (it must be necessary and emergency care) an alien needs to prove that he/she is the citizen of 3 the state with which the agreement was signed. If he/she does so, the care provided is covered by the Ministry of Health. The CR has concluded bilateral agreements regulating the mutual free provision of emergency medical care. The list of such states can be found on the website of the Centre of Interstate Payments Centrum mezistátních úhrad. Points of contacts in the CR for international agreements on social care. There is a second type of new agreements on social care, which also include provision of health care. Based on these agreements health insurance claim can be transferred to the territory of another state which is a party to an agreement. To be able to set up a claim in accordance with these agreements it is necessary to adhere to certain administrative procedures. Generally it can be stated that the care provided on the basis of such agreements is limited to necessary and emergency care only; however extended care can also be provided upon a prior approval of a respective health insurance company. Every person traveling to the CR should contact respective bodies and inquire, whether he/she meets requirements defined by the international agreement. List of international agreements on social welfare is available at the internet address of Česká správa sociálního zabezpečení (the Czech Social Security Administration) or at the website of the Ministry of Labour and Social Affairs. Questions and answers concerning the extent of care which is covered by health insurance How do I know that a physician is not misusing my position of an alien, when asking me to pay too much in cash? Haw can I defend myself? In case that you are insured within the system of public health insurance, you cannot be asked (except for exemptions defined by law) to pay in cash for the care provided. In case that you are insured on the basis of an insurance contract, you are entitled to health care that is to be provided in compliance with General Terms and Conditions of Insurance. Mostly the health care is provided for free. In case that you have visited a healthcare facility and you are required to pay for the care which is covered by your insurance, it is necessary to contact your assistance service and of course you have the right to refuse paying in cash. If you have already paid a required amount, ask for the document proving the payment; this document should specify a medical procedure which has been performed. Justification of requiring direct payment for health care provided can be checked with the insurance company (if you are the insured of VZP, then with its assistance service) and if the payment was required unduly, you should claim the reimbursement of the amount by the insurance company. Payment should always follow the provision of care. 4 If you have no health insurance, it is necessary to agree on conditions under which a health care facility will provide treatment. Every health care facility has a price list of medical procedures. How to pay for health care which is not covered by my health insurance? Payment for health care which cannot be covered by the public health insurance needs to be done directly in cash. How to pay for pharmaceuticals? What should I do, if a pharmacy requires to pay in cash for prescribed drugs? If you are insured within the system of public health insurance, you are entitled to the provision of pharmaceuticals. It is quite common that some drugs should be co- financed by a patient. This supplementary payment is nonreversible. Eligibility of a supplementary payment can be checked in the pharmacy (eventually in a doctor’s office), namely by looking at the pricelist of pharmaceuticals. If your health insurance is based on a long term health insurance contract, you are entitled to pharmaceuticals and medical supplies at the same extent as person insured within the system of public health insurance, with the exception of hearing aids, electric wheelchairs and myo-electric prosthetics. It should be noted that in accordance with General Terms and Conditions of Insurance of the VZP for a long term health insurance you are obliged to pay in cash for drugs in a pharmacy. You are entitled to reimbursement of these costs at any VZP branch office upon the submission of a receipt (prescription verified by the pharmacy when supplying the drugs). If you have a short term contractual insurance, drugs prescribed by a physician during out patient treatment are not covered by the insurance. Drugs provided during hospitalization are included in hospitalization costs and they are fully covered by insurance company. How to pay for emergency and rescue service? Intervention of the emergency and rescue service in this case is a part of emergency medical care and is covered by insurance. What are the amounts of supplement payments for dental care? Do I have to pay for all dental care provided by a dentist, or is a part of it covered by insurance? 5 If you are insured within the system of public health care insurance, dental care will be provided for free to the extent defined by law (this applies to primary care only). However you can also select procedures which are not covered by insurance and which you will need to co-finance, or which you will have to pay for. The doctor is obliged to inform you in advance about a supplement charge or the level of a complete payment. The situation differs in case that you have a health insurance contract. If it is a short term contractual insurance, only acute dental care up to the limit of an insured event is covered. If you have a long term contractual insurance, the care is covered by insurance only in case of the treatment of consequences of an accident. However, you can effect above standard type of insurance covering acute dental care up to CZK 5000. Dental care which is not included in the Terms and Conditions of Insurance are paid by a patient. 6
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