Main types of regulation fees
The four main types of regulation fees described below in detail were introduced on 1 January 2008. All the regulation fees apply only to medical procedures, medicines and stays, which are reimbursed in part or in full from public health insurance. They do not apply to the provision of health care, which was not covered by public health insurance, or when a party other than a health insurer pays (such as procedures performed by order of a court, public prosecutor, the police).
I. Regulation fee for visit to a physician
A regulation fee of CZK 30 is charged for visiting a doctor if the conditions below are satisfied.
Insured persons only pay the regulation fee if a clinical examination is carried out during the visit to:
- a general practitioner for person after the age of 18,
- a general practitioner for children and adolescents after the age of 18 until the age of 19,
- a gynaecologist for women after the age of 18,
- a dentist for person after the age of 18,
- an outpatient specialist for persons after the age of 18, including outpatient departments of health care facilities, on working days from 07:00 to 17:00, where the working hours may be beyond 17:00, which is decided by the operator of the health care facility. The outpatient department must be marked accordingly to indicate whether it operates within its working hours or as an institutional emergency service from 17:00,
- a clinical psychologist,
- a clinical speech therapist,
- a visiting service provided by a general practitioner or general practitioner for children and adolescents to a patient after the age of 18.
Clinical examination means a comprehensive, targeted and controlled examination with appropriate procedures in the speciality according to the list of procedures.
For example, insured persosn do not pay a physician’s visit fee:
- unless a clinical examination has been performed,
- if a physician visits a child up to the age of 18 ,
- for preventive examination,
- for dispensary care for a pregnant woman,
- for laboratory or diagnostic examination (e.g. taking a blood sample),
- for examination by a transfusion service physician taking a sample of blood, plasma or bone marrow,
- for physician’s interview with the family,
- for telephone consultation between physician and patient,
- for examining a corpse outside inpatient establishment,
- for procedures done at patient’s request (e.g. health certificate for a student),
- for procedures done by order of a court, public prosecutor, state administration authorities, Czech Social Security Administration, job centre, the police.
Ways of paying the fee by insured persons:
The regulation fee is paid by the insured person on the spot or upon agreement with the health care facility.
II. Regulation fee for prescription medicament
The fee of CZK 30 applies to dispensation of one type of a medicament, which is one item on a prescription. Up to two items may be on one prescription (two different medicaments). If the insured person pays surcharge for issuing a prescription medicament or foods for particular medical uses, the total sum of surcharges for all packages of the medicament or foods of one type is reduced by the paid regulation fee or its relevant part so that the amount paid by the insured person for both the surcharge and regulation fee is CZK 30 at minimum.
Payment of regulation fee: The regulation fee is paid on the spot or upon agreement with the health care facility.
III. Regulation fee for an emergency visit
The regulation fee is CZK 90.
An insured person pays a regulation fee for emergency service provided by a health care facility offering:
- first-aid service, including dental emergency service,
- institutional emergency service on Saturdays, Sundays and public holidays (24 hours a day) and on working days from 17:00 to 07:00 (the regulation fee is only paid if the insured person is not subsequently taken into institutional care).
Insured persons do not pay the regulation fee of CZK 90 in an institutional emergency:
- on working days from 07:00 to 17:00,
- if the insured person is subsequently taken into institutional care in the health care facility where institutional emergency service has been provided.
Payment of fee: On the spot in the health care facility or upon agreement with the health care facility.
EXAMPLE:
You are going to collect a prescription medicament from an emergency pharmacy service. You will be asked to pay a regulation fee, not of CZK 90 but only CZK 30, because only CZK 30 is paid to the emergency service if the medicament is partly or fully reimbursed from public health insurance.
IV. Regulation fee for a hospital stay
Every hospital stay of an insured person encompasses not only the use of health care but also “consumption” of certain ancillary costs. Should the person stayed at home, he or she would consume under the same circumstances energy and spend money on food or cleaning and yet would not have sufficient care at professional level. As a token of these expenses, the sum of CZK 60 has been fixed for each day patients are provided with:
- institutional care (in hospitals, specialized health care institutions, after-care centres and long-term facilities),
- comprehensive balneological care,
- institutional care in children’s hospitals and sanatoria, where the day when an insured person is admitted for such care as well as the day in which the provision of such care is terminated count as one day. The same rule applies to the stay of persons accompanying children if the stay is reimbursed from public health insurance.
Insured persons do not pay the regulation fee for a visit to GP in case of:
- institutional care for a newborn child, from the day of birth to the day of release from the institutional health care facility where the birth took place, or to the day of release from another institutional health care facility to which a child was transported for health reasons immediately after birth,
- one-day bed care,
- stay in short stay ward,
- patient on leave,
- provision of contributory balneological care and hospice care.
Ways of paying the fee by insured persons:
Patients or legal guardians, or their accompanying person, must pay a regulation fee in an amount depending on the number of days spent in the health care facility.
- If time of their stay was shorter than 30 days -> not later than eight calendar days after their release from institutional care.
- If an insured person spends in a health care facility more than 30 days -> as of the last day of each calendar month.