Ministerstvo zdravotnictví České Republiky

Rights and obligations of participants in public health insurance

Participants in public health insurance have the following rights:

1. to choose a health insurer – once every 12 months, always as of the first day of the calendar quarter;
2. to choose a physician and health care facility, with the exception of industrial health services, which is contracted to the health insurer; this right may be exercised every three months;
3. to choose a transport service which is contracted to the health insurer;
4. to health care without direct payment if it was provided within the scope of and subject to the conditions laid down in the Act on public health insurance;
5. to medicaments and special diets without direct payment if they are medicaments and special diets reimbursed from health insurance and prescribed in conformity with this Act;
6. to participate in control of health care paid out of health insurance;
7. to have a certificate issued on payment of the regulation fee; the health care facility is obliged to issue the certificate to the insured person on request;
8. to have a certificate issued on payment of the regulation fee and payment of the surcharge for the issue of a partly reimbursed medicament or special diet by a pharmacy; the pharmacy is obliged to issue the certificate to the insured person on request;
9. to payment of a sum in excess of the limit for the regulation fees and surcharges for prescribed partly reimbursed medicaments or special diets by the health insurer within a time limit laid down by law.

Participants in public health insurance are obliged to:

1. fulfil their reporting duty;
2. tell their employer on the day they begin their employment with which health insurer they are insured. They have the same obligation if they register with another health insurer while in employment;
3. pay premiums to the health insurer;
4. cooperate in treatment;
5. undergo preventive examinations on request;
6. adopt measures designed to prevent illness;
7. abstain from wilful conduct known to damage health;
8. use, for the purposes of provision of health care, with the exception of the provision of medicaments and medical devices, a valid insurance card or a substitute card issued by a health insurer;
9. report to the health insurer loss or damage to the insurance card within eight days ;
10. return to the health insurer the insurance card within eight days in the event of:
    
    • termination of health insurance,
    • change of health insurer,
    • long-term stay abroad,
       
11. report to the health insurer changes in the name, surname, permanent residence or birth certificate number within 30 days as well as loss of or damage to the card within eight days;
12. if a self-employed person changes health insurer, present to the new health insurer evidence of the amount of advance premium payments calculated from the assessment base;
13. pay to the health care facility regulation fees.

Rights and obligations of participants in public health insurance stem from Act 48/1997 Coll., on public health insurance, amending certain related acts.

Non-fulfilment of the obligation to pay insurance contributions does not invalidate the contract with the health insurer or one’s entitlement to health care. Failing to pay the contributions is penalized by the health insurer and the insurer then claims it together with the unpaid contributions.

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