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Information about health insurance for foreigners


Scope and type(s) of insurance:

 

1.1 Cross-border commuters

Cross-border commuters are citizens of the Czech Republic who live in the Czech Republic and work in another EU Member State where they have taken out health insurance for themselves and their spouses and children. As long as they maintain the aforementioned insurance, they do not need to pay health insurance premiums in the Czech Republic. However, they are entitled to the types of medical care marked with a cross in the form Certificate of registration – sample number 1 (the insurant shall obtain this certificate from the health insurance company they had before they left to work abroad). The cross-border commuter or his or her spouse/child must present this certificate upon their visit of a medical care facility.

 

The insurant must submit the Certificate of registration to allow the making of copies of documents which are kept in the patient’s file.

 

1.2 Foreigners from EU Member States, EEC countries and Switzerland

In addition to insurants from EU Member States this category includes, as of
1 January 2007, insurants from Romania and Bulgaria and, upon the basis of international treaties, Croatia and other countries of the former Yugoslavia, Israel and Macedonia.

Insurants from the EU, EEC, Switzerland and countries which are signatories of international treaties are entitled to the so-called necessary and inevitable medical care or to comprehensive medical care based upon the type and scope of their insurance, as proved by cards and certificates.

The insurants must submit:

  1. Certificate of registration issued by a Czech health insurance company of their choice
  2. European Health Insurance Card or a temporary certificate used in lieu of the EHIC


Re 1.: CERTIFICATE OF REGISTRATION – specimen number 1

The certificate of registration specifies the type of medical care the insurant is entitled to, as well as the name of the Czech health insurance company which shall bear the costs of treatment. This certificate of registration is submitted by foreigners staying in the Czech Republic temporarily for an extended period of time who have registered with a Czech health insurance company of their choice in order to facilitate medical treatment.


Re 2.: EUROPEAN HEALTH INSURANCE CARD – specimen number 2

or TEMPORARY CERTIFICATE USED IN LIEU OF EHIC – specimen number 3

 

The aforementioned documents shall be submitted by persons staying in the Czech Republic temporarily.

 

  • In both cases a foreign insurant is entitled to urgent and inevitable medical care, considering the nature of the illness and expected length of stay.
  • If a foreign insurant submits any of the aforementioned documents, he or she will receive medical treatment in the healthcare facility at the expense of the respective Czech health insurance company. The document must be valid on the day of treatment.

 

The healthcare facility shall assist the foreigner in filling out the so-called Certificate of entitlement of insurant from EU Member State – specimen number 4 and the foreign insurant chooses from among Czech health insurance companies that shall bear the costs of treatment. Based upon his or her medical condition, the patient is asked to choose a contractual Czech health insurance company himself or herself. If, due to his or her medical condition, the patient is unable to do so, the healthcare facility will choose the health insurance company. The patient or the healthcare facility can choose any health insurance company that has a contract concluded with the facility.

 

Based upon the documentation submitted, the healthcare facility will charge the medical care to the respective Czech health insurance company. Subsequently, this health insurance company will request the settlement of the costs of treatment from the foreign health insurance company where the foreigner has taken out their insurance policy.

 

If a foreigner-insurant hails from the EU or EEC but has no ID:

 

The handling of this issue depends on whether it is an outpatient treatment procedure or hospitalisation.

  • In the case of the former, the patient may be asked to pay in cash in accordance with the applicable Czech legislation.

  • In the case of inevitable hospitalisation the hospital will ask for the Temporary certificate used in lieu of EHIC.

  • Should the patient be unable to provide sufficient data for the procurement from abroad of the Temporary certificate used in lieu of EHIC, they shall pay directly in cash in accordance with the valid price list.

     

1.3 Patient with health insurance policy

It can be any foreigner who submits a health insurance certificate proving the existence of a health insurance policy entered into with any Czech health insurance company or who has taken out a foreign insurance policy via a Czech branch. The medical care provided to the patient is charged directly to the health insurance company.

 

1.4 Private payers

Private payers are foreigners who do not belong to any of the aforementioned three groups. In other words, they are neither cross-border commuters to an EU Member State nor citizens of the EU, EEC, Switzerland or countries which are signatories to international treaties who submit documents, nor insurants who have taken out an insurance policy. They have to pay for medical treatment using their own financial resources.

 

1.5 Other types of insurance

Occasionally, hospital treatment can be required by foreigners whose medical treatment costs are covered directly by the Ministry of Health. These persons include students studying in the Czech Republic whose costs of studies are borne by the Czech Republic; refugees who have been granted the refugee status and temporary asylum seekers. These foreigners must submit, prior to receiving medical treatment, the appropriate certificate confirming their status of (1) a student studying at the expense of the Czech Republic or (2) an asylum seeker, respectively.

 

1.6 Planned care in the Czech Republic

“Planned care” is medical care governed by the transposition of directive number 24/2011 (as implemented in the Czech Republic by virtue of the amendment of act number 48/1997 Coll., effective as of 22 April 2014), if a foreign insurant has intentionally arrived in the Czech Republic to receive it. Typically, the provision of this type of requested medical care is arranged with the healthcare facility in advance.

- if the patient submits a certificate of registration issued by a Czech health insurance company

  • Foreign insurant submits to the healthcare facility a Certificate of registration issued by a Czech health insurance company which indicates that the patient is entitled to receive the planned medical care. At least a general specification of services which may be provided should be attached to the certificate.

 

- if the patient submits a foreign-issued document proving their entitlement

  • Valid documents proving the patient’s entitlement may include the forms S2 or E112 issued by a foreign health insurance company. Unless otherwise arranged in advance, the patient must be asked to register with a Czech health insurance company of their choice with the document, prior to the provision of the planned medical care. Based upon said registration, they will be issued a Czech Certificate of registration, including a Czech health insurance registration number.

 

- if the patient does not submit any of the aforementioned documents and wishes to pay for the planned treatment using their own financial resources

  • Insurants may receive planned medical care in any healthcare facility anywhere in the EU, even without their health insurance company’s consent. They shall settle the bill in cash and then ask their health insurance company for the compensation of the costs incurred. The health insurance company will grant the amount it would have granted, had the same type of medical treatment been received in the insurant’s own country. In any event, the amount granted shall not exceed the amount actually paid by the insurant. The reimbursement is based on the condition that the treatment is a paid type of treatment in the patient’s home country. Other special conditions must also be fulfilled with regard to the compensation in the state of insurance (e.g. recommendation by the patient’s physician prior to the operation).