Healthcare services paid for by public health insurance

In the Czech Republic, healthcare services are basically paid for by one of the public health insurance companies. All individuals have to have insurance – it is mandatory and no qualifying individual can be denied coverage by a public health insurance company. In the case of an employment relationship, the employer pays for the health insurance at the rate of 13.5% of the calculated base income (of which one third is paid by the employee and two thirds by the employer). In certain cases, the insurance premiums are paid for by the state (dependent children, pensioners, etc.).

A foreign person participates in the public health insurance program and obtains the same rights to receive the care, which is paid for by a public health insurance company (hereinafter as "covered healthcare services") as any other insured person, if they are either of the following:

  • a person with a ‘permanent resident’ status in the Czech Republic;
  • working as an employee of an employer (company, etc.) with a ‘registered address’ or an individual with ‘permanent residence’ in the Czech Republic.

The following is a list of “covered healthcare services” (note that in certain situations, the services may not be fully covered by the public health insurance provider):

  1. preventive, dispensary, diagnostic, therapeutic, therapeutic-rehabilitative, spa therapeutic-rehabilitation care, including examinations, nursing and palliative* care and care for the donors of blood, tissues or organs and cells in relation to their removal – pursuant to the provisions of the Health Services Act;
    • * In this case, the term “palliative care” means care for the dying – which is an adequate level of care based on the condition of the patient, such that it won't burden the patient and will allow the patient to live as well as they can and with dignity until the end of their life.
  2. medicinal products, foods for special medical needs, medical devices and dental products;
  3. transportation of the insured individual and reimbursement of travel expenses (as part of the provision and use of the covered healthcare services);
  4. blood and tissue samples, cells and organs for transplantation purposes and any necessary handling (preservation, storage processing and testing);
  5. transportation of a living donor (of tissues, cells and organs for transplantation) to and from the place of collection (removal) and the providing of healthcare related to the collection and reimbursement of travel costs;
  6. transport of a deceased donor to and from the place of collection (pickup);
  7. transportation of any removed samples of tissues, cells and organs;
  8. the examination and autopsy of a deceased insured person - including transportation;
  9. the stay of a person accompanying an insured person to a medical facility for inpatient care (hospital);
  10. medical care related to pregnancy and the birth of a child where the mother has asked for confidentiality in connection with the childbirth (this care is covered by health insurance, where payment is requested by the provider (medical facility, hospital) based on the identification of the insured person).

Covered healthcare services are provided by medical professionals and other medical specialists on the basis of their professional and specialized medical qualifications.

Covered healthcare services are provided in clinics and hospitals and they are paid for by the health insurance company on the basis of a contract between the provider of the healthcare services and the health insurance company of the insured person.

This does not apply to pharmacies because the insured person can pick up their prescriptions at any pharmacy, irrespective of the pharmacy’s having a contract with the health insurance company. However, the prescription must generally be written by a doctor who has a contract with the health insurance company, through which the patient is insured.

Only on an exception basis can covered healthcare services be provided in a location or through a facility that does not have a contract with the insured person's health insurance company.

Patients are asked to make a co-payment towards the cost of certain drugs. Drugs are categorized into groups, where in each group of drugs (the so-called “indicative group” – based on the type of illness), at least one drug in the group must be fully covered by health insurance (i.e. the drug has no co-pay required).

During hospitalization, an insured person does not pay any of the cost for medicines or medical devices. These costs are fully covered by the health insurance company.

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Published: 11.12.2012

Last change: 24.06.2014, 14:41