Health Insurance - Long Term Stay - non EU
HEALTH INSURANCE FOR FOREIGNERS with Stay More Than Three Months - non EU countries citizens
Each foreigner who wants to stay in the Czech Republic must be medically insured.
There are two types – public and commercial health insurance.
Participants in the public health insurance system include:
- citizens of the CR permanently residing in the CR
- foreigners permanently residing in the CR
- employees without permanent residence in the CR whose employer is a company or corporation residing in the CR
- someone applying for international protection
- a foreigner who has been granted asylum or supplementary protection
- a foreigner with a long-term visa or long-term residency for leave to stay in specified cases
- Specifically certain foreigners can have entitlement to public medical insurance on the base of an international treaty on social security concluded btw the Czech Republic and the given country. Currently these may be some citizen of former Yugoslavia, recently of 2016 citizens of the USA with long-term residence permit in the Czech Republic on freelance (business visa).
For these persons, participation in the public health insurance system is mandatory and required by law.
Commercial health insurance is mandatory for:
- foreigners with a long-term visa and long-term residency permit who are not employed by a company residing in the CR
- foreigners with temporary residency of an EU-citizen family member
PUBLIC HEALTH INSURANCE
How do you become a participant in the public health insurance system?
HEALTH INSURANCE STARTS:
- upon birth, if the newborn child’s legal guardian has permanent residence in the CR and if he/she applies within 60 days from the day the child was born for permanent residence status for the child,
- the day person without permanent residence in the CR becomes an employee of an employer (company) residing in the CR,
- the day you were granted permanent residence in the CR
- when you submit an application for an international protection,
- when asylum or supplementary protection in the CR is granted,
- in some circumstances for family members of an EU citizen, who works or worked in another EU country are eligible. More information can be obtained from the insurer (insurance company) of the EU citizen.
If you are entitled to participate in public health insurance, you have right to choose from several health insurance providers which operate in the CR. An exemption is a child born in the territory of the Czech Republic, who is insured in the same insurance company as her/his mother (you must inform your health insurance company about birth within 8 days). All insurance companies provide the same coverage of health care by law; the only difference can be an offer of some benefits, discounts and allowances.
THE HEALTH INSURANCE EXPIRES:
- the day a person without permanent residence ceases to be an employee,
- after permanent residence status in the CR have been cancelled,
- when you apply for an international protection and the procedure is abated or if the application was turned down,
- after the international protection status have been cancelled or expired,
- when the visa for over 90 days for leave to stay or long term residence permit for leave to stay in the CR was cancelled or expired,
- in case a foreigner dies or is pronounced dead.
WHAT IS INSURANCE PREMIUM?
Insurance premium is the amount of money you pay to the insurance company, usually monthly.
If you are an employee, the insurance premium is paid by your employer. If you have an employee contract or an employment agreement of work activity (dohoda o pracovní činnosti) and your monthly income has reached certain amount (at least 3500,- Czech Crowns a month in 2021), your employer is obliged to pay your insurance premium. Part of the premium (2/3) is paid from the employer’s funds; the remaining part (1/3) is deducted from your paycheck. If you suspect your employer (company, agency) is not paying health insurance premium properly, you can obtain a receipt of what have been paid from your insurance company.
In case your employer or the state does not pay or in case your income has not reached certain amount (at least 3500,- Czech Crowns a month in 2021), e.g. if you have a contract for specific work with limited hours, or you are an irregular or occasional worker, etc, you have to pay medical insurance premiums yourself, in 2021 it is 2052 CZK per month.
WHEN THE STATE CAN PAY HEALTH INSURANCE FOR YOU?
The state (government) pays insurance premium for:
- Dependent children, retired seniors who receive pension under the Czech law, social welfare recipients, people who depend on help of others and also their caretakers, people with certain handicap, parents who personally provide full time care to a child under seven years of age or two children under 15 years of age, job seekers registered in Labor Office, recipients of the parental benefit, recipients of the sickness insurance benefits (sickness benefit, maternity benefit), etc.
- International protection seekers,
- Foreigners who have visas for stay over 90 days for leave to stay or who have long-term residence permit for leave to stay in the territory of the CR in cases specifically defined in Act on Residence of Foreign Nationals.
- In specific situations also foreigners with long-term residence permit – when you are recipient of sickness benefit, maternity benefit or parental benefit and your employment contract is still active
- If the state is to pay the insurance, the state covers insurance for full calendar month even if the person was in the specific situation only for a part of the month (e.g. you register as unemployed with the Labour Office at mid-month, the state covers that months fully).
WHAT ARE THE CONSEQUENCES IF YOU DO NOT PAY HEALTH INSURANCE PREMIUM?
If you do not pay premium in correct amount and on time, you will have debt which the insurance company will to claim in legal procedures, including interest on the debt. Also, any debts in insurance premium are considered a serious obstacle in your possible application for citizenship of the Czech Republic.
WHEN ARE YOU NOT REQUIRED TO PAY HEALTH INSURANCE PREMIUM?
You are not required to pay if you are staying abroad for longer than 6 months in case you are medically insured abroad and you informed your health insurance company in writing and in advance. During this time, until you register with your Czech insurance company again, you are not entitled to cover your health care costs from public health insurance. You must submit a document proving that you were insured abroad and for how long. If you do not submit this document, you will have to pay your insurance premium retroactively.
COMMERCIAL HEALTH INSURANCE
What type of commercial insurance are you required to have?
- If you are not enrolled in public health insurance, you are required to obtain commercial health insurance.
- If you live in the CR for more than 3 months, if you are applying for long-term residency or for an extension of long-term residency permit, you must have comprehensive (complex) health insurance.
- Evidence of insurance coverage must be shown when a long-term residency permit is being issued or extended. The insurance company providing the coverage must be authorized to offer such insurance in the Czech Republic.
- At present the authorized insurance companies include: VZP Insurance (note: VZP Insurance is not the same as the VZP public health insurance), Uniqua, ERGO, AXA Assistance,Maxima and Slavia Insurance.
- The terms and conditions of these insurers differ, particularly with regard to exclusions, minimal length of term, waiting times for cancellation, and cost of insurance.
COMPREHENSIVE (COMPLEX) HEALTH INSURANCE
- Comprehensive (complex) offers coverage which approaches that of the public health insurance (it includes, for example, child immunizations, some preventive care, pregnancy and childbirth).
- Insurance can be purchased for a period from 4 months up to two or three years.
- The insurance covers care provided at a designated, participating facility. Each insurance compaly has contracts with chosen doctors and facilities, only for urgent care and acute conditions you can use any healthcare facility. Some insurers require that the insured contacts their service center prior to receiving care.
- The insurance company can require a medical entrance examination and is not obligated to offer you coverage (it may refuse to insure you).
- The insurance premium (cost) differs among insurers, and depends on your sex, age, and coverage options (variants).
- Comprehensive (complex) insurance coverage is always limited as far as the total healthcare costs are concerned. Carefully study the terms of the insurance coverage, in particular “exclusions”, which differ among insurers. "Exclusion" means that the specific situation or illness is not covered.
- Compare the terms of several insurance companies before purchasing. From 2016 most companies have changed their conditions and abolished the most problematic exclusions (e.g. treatment of diabetes, hepatitis, mental illnesses, child congenital diseases are now covered by the insurance). Still each insurance company excludes differently certain situations from coverage.
- Commonly for all companies, insurance does not cover treatment in specialized medical facilities (e.g. mental hospitals), treatment if the injury resulted from deliberate action on your part, or if the symptoms of a condition become apparent prior to when the insurance commenced or during a waiting period. Only acute dental care is covered.
- In addition to standard insurance, insurance companies offer various special insurance variants (options), for example expanded coverage throughout the Schengen countries, coverage for sport activities, for pregnancy and childbirth with coverage for the newborn. (This is coverage for the initial and uninterrupted hospital stay of the newborn from birth for up to 3 months.) This special variant is more expensive than common complex insurance and covers care during pregnancy and childbirth without waiting period, a woman can arrange this variant of insurance also when already pregnant.
- Be aware of when the coverage commences and about the waiting periods. For example, the standard-type insurance variant has a waiting period of 3 months for pregnancy and 8 months for childbirth. If you become pregnant sooner than 3 months or give childbirth sooner than 8 months from when coverage commences, the standard insurance variant will not cover the pregnancy or childbirth. For these situations you can obtain a pregnancy/childbirth insurance variant.
- If you receive medical care from a doctor or facility which does not have a contract with your insurance (is not a “participating” facility), you may be required to pay in cash. You may be told that the insurance company will reimburse you; however, the insurance company will only pay up to certain limits or at specific rates. You will not be reimbursed for any amounts you paid over these limits.
- When concluding complex medical insurance with another company than previously, or you had time gap between insurance periods, it is considered new insurance - the exclusions from coverage and waiting periods are calculated from the beginning.
IS IT ENOUGH TO HAVE INSURANCE COVERING NECESSARY AND ACUTE CARE (Basic insurance)?
- You may have this type of insurance when obtaining short or long-term visa at a consulate/embassy. This type of insurance is intended for short stays and you can obtain it as travel insurance in your country of origin or from an insurer in another EU country.
- When applying for a long-term visa (stays longer than 90 days) at a consulate or embassy in your country of origin, you must show, when picking up the visa, proof that you have travel insurance. The insurance must cover necessary and acute care with a limit of at least 60 000EUR. The insurance must cover the cost of care in case of injury or sudden illness while in the CR, as well as the cost of transporting you back to your country of origin (or to another country where you are allowed to reside) up to 60 000EUR, not including any deductibles or co-pays. This insurance must not exclude injuries which occurred after consuming alcohol, narcotics or addictive substances, or injuries which resulted from deliberate action on your part.
- The insurance of necessary and acute care has considerably smaller extent than the complex care (exactly it is medical care in condition which directly endangeres his life, e.g. an injury).
ARE YOU UNINSURED, OR DO YOU KNOW SOMEBODY WITHOUT HEALTH INSURANCE?
During your stay in the CR you are obligated to have health insurance. Proof of insurance must be shown when applying for or extending residency, or during a residency status check.
If for some reason you do not have health insurance, doctors and/or medical facilities may require you to pay cash for any type of examination, treatment or medical procedure. They will charge you contract prices which can be very high.
In addition, failure to arrange obligatory health insurance can be reason for rejecting of valid residence permit in the CR.
These information are applicable to citizen of non-EU countries. If you are a citizen of EU country, different rules apply to you - EU co-ordination of social security systems.