Full text of Act No. 117 / 1993 Coll.
Ordinance of the Government of the Czech Republic issuing the Health Regulations and implementing certain provisions of the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance (full text as follows from subsequent amendments and additions)
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117
THE PRESIDENT OF THE GOVERNMENT OF THE CZECH REPUBLIC,
Announces
the full text of the Decree of the Government of the Czech Republic No. 216 / 1992 Coll., which publishes the Health Regulations and implements certain provisions of the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as follows from amendments and additions made by the Government of the Czech Republic Act No. 50 / 1993 Coll.
GOVERNMENT REGULATION
the Czech Republic,
laying down the Health Regulations and implementing certain provisions of the Czech National Council Act No. 550 / 1991 Coll., on General Health Insurance
The Government of the Czech Republic orders the implementation of the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as amended by the Act of the Czech National Council No. 592 / 1992 Coll., Act of the Czech National Council No. 10 / 1993 Coll. and the Act of the Czech National Council No. 15 / 1993 Coll.:
SCOPE OF HEALTH EQUIPMENT
The necessary health care without the need for direct remuneration is provided to insured persons on the basis of general health insurance. Its scope and level are determined by the degree of disability of the insured and the amount of financial resources to cover the necessary health care.
Diagnostic and curative care
Individual diagnostic, outpatient and institutional care, including rehabilitation and chronic care, are included in the list of health performance with points (hereinafter referred to as "the list of performance ') .1)
(1) If the treating physician has doubts as to whether the health performance covered by the necessary health care is concerned or if he is necessarily in need of performance beyond this level of disability, he shall request the medical insurance undertaking chosen by the insured person before carrying out his consultation (hereinafter referred to as "the medical practitioner"). If, due to the degree of disability of his or her health status, the insured person is performing an urgent medical exercise beyond the necessary medical care, the treating doctor shall notify the medical practitioner after the performance of the medical examiner. The revised physician shall assess the justification for such medical performance. The medical performance recognised by the medical examiner as necessary shall be paid by the health insurance undertaking at the cost of its implementation. The medical performance not recognised as necessary by the medical practitioner shall not be reimbursed by the health insurance undertaking; in such a case, the costs of the health care facility of the treating physician shall be borne.
(2) The provisions of paragraph 1 shall also apply to cases relating to the execution of the necessary and urgent performance which is not included in the list of performance but which, according to the treating physician, is in the interest of the health of the insured person.
(3) The treating physician referred to in paragraphs 1 and 2 shall be the doctor who has custody of the insured person.
Prevention
(1) In the context of the provision of the necessary health care, the insured person shall be subject to preventive examinations every two years, unless otherwise specified. A preventive examination is carried out by the chosen physician, unless it is clear from the health file of the insured person that the examination has been carried out or that the insured person has been examined in the last two years to the desired extent.
(2) A preventive survey shall be carried out for children and adolescents:
(a) nine times a year in the first year of life, of which at least six times in the first half of a year of life, and of which at least three times in the first three months of life, provided that they are not provided with dispensary care under Article 6 (1) (a);
(b) at 18 months of age,
(c) at 3, 5, 7, 9, 11 and 13 years,
(d) at the end of compulsory education or at the age of 15.
(3) A preventive survey is carried out for pupils and students:
(a) when entering a secondary school, provided that it has not been completed during the last year as referred to in paragraph 2 (d), once every two years and at the end of the secondary school;
(b) when entering a university, then once every two years and when leaving a university.
(4) A preventive examination is carried out in the field of dentistry:
(a) children and adolescents under the age of 18 twice a year;
(b) in pregnant women, twice during pregnancy,
(c) adults once a year.
(5) In the field of gyno, a preventive examination is performed once a year.
(1) The health care required also includes examinations and examinations carried out under measures against communicable diseases (2) Surveys of insured persons carrying out epidemiologically significant activities carried out in connection with the issue of a health certificate shall not be included in the necessary healthcare.
(2) The necessary healthcare also includes:
(a) established vaccination (3) carried out by medical care centres;
(b) the provision of rabies vaccines, tetanus vaccines in wounds and non-healing wounds, tuberculosis and tuberculosis testing using a tuberculin test;
(c) the collection of materials carried out at care facilities for microbiological, immunological and parasitological examination for clinical purposes and in relation to the occurrence of diseases;
(d) testing of the materials referred to in point (c) of the laboratories of the contractual health establishments;
(e) HIV and HBsAg diagnostics in donors of blood, organs and semen and HIV diagnostics carried out in treatment facilities where the investigator requested this, except:
1. anonymous examinations,
2. examination for private and work travel abroad.
(3) The necessary healthcare does not include:
(a) vaccination carried out by health service facilities;
(b) the provision of vaccines with the exception referred to in paragraph 2 (b);
(c) the collection and examination of materials carried out by sanitary services facilities;
(d) HIV diagnostics, including tests carried out in sanitary facilities at the request of the insured person, including anonymous examinations.
Dispensary care
(1) In the context of the necessary health care, dispensary care is provided to insured persons who are healthy, vulnerable and ill in the following groups:
(a) children within one year;
(b) selected children from one year of age who are chronically ill and at risk of health disorders, including as a result of unfavourable family or social conditions;
(c) selected young persons,
(d) pregnant women from the date of detection of pregnancy,
(e) women who use hormonal and intrauterine contraception,
(f) insured persons at risk or suffering from serious diseases.
(2) The selection of insured persons for the disability care is carried out by treating doctors.
(3) The conditions and scope of dispensary care are laid down in specific regulations.4)
The medical care required includes the examination, the transport to the autopsy and the autopsy of the deceased (5), except for the judicial autopsy and transport to it.
Racing preventive care
Racing preventive care ensures, in cooperation with the employer, prevention, including protection of workers' health against occupational diseases and other damage to health from work and prevention of accidents. This care shall be borne by the health insurance company, except for the costs of preventive hygiene activities.
Provision of medicines and medical devices
(1) Individual medicines and medical devices (hereinafter referred to as "medicines and devices"), including the price limit and the method of payment by the health insurance company, are listed in the list of medicines and devices. 6)
(2) The health insurance company pays the medicines and means prescribed or provided by the contractual health establishments under specific rules. 15)
Transport and reimbursement of travel expenses
(1) Transport is provided on the territory of the Czech Republic to an insured person if, according to the doctor's opinion, his medical condition requires him to be transported to a medical institution, transferred to another establishment or transported back to the place of stay at the time of the disease or, where appropriate, to a permanent or temporary residence. This also applies in the case of the release of a child of childbearing age from institutional care. The health insurance company shall also pay the costs provided by the carrier other than the contract transport service up to the amount specified by the list of performance.
(2) Transport to a health establishment, between health establishments, between health establishments and social care establishments is covered by a health insurance company at an equivalent distance to the nearest contractual health establishment capable of providing the necessary health care.
(3) Transport from a medical establishment is covered by a health insurance company at an appropriate distance from the nearest contractual medical establishment capable of providing the necessary medical care to the place of permanent residence. If the disease has occurred at the place of temporary residence, the transport back from the medical establishment shall be paid for to a further permanent residence only if, according to the doctor's opinion, the health of the insured person so requires.
(4) The transport of insured persons to the infectious ward shall be carried out by vehicles designated for that purpose; this transport is part of the necessary health care.
(5) The required health care also includes transport by special sanitary vehicles corresponding to the requirements laid down by the Ministry of Health of the Czech Republic, provided that it has been recommended by the treating doctor or, in urgent cases, by the treating doctor subsequently approved.
(6) In exceptional cases indicated by the doctor on the basis of the health status of the insured person, the health insurance company will pay both the necessary air transport. Such transport must be approved in advance by a revision physician.
(1) If the medical condition of the insured person so requires, he shall be reimbursed for the necessary travel costs to the nearest contractual medical establishment, except for local transport costs, on the basis of a medical certificate. Costs shall be borne at the rate corresponding to carriage by passenger train of 2nd class or by bus; the cost of express travel shall be paid at a distance of more than 100 km and in cases where the use of the express travel allows the arrival after 6 o'clock or its termination before 24 o'clock. If it is economically more advantageous, the health insurance company will also pay the costs of air transport.
(2) On the basis of the advice of the treating physician, the transport costs of the guide shall be reimbursed to the extent referred to in paragraph 1 if, taking into account the medical condition or age of the insured person, accompanying is necessary.
(3) The costs are borne on the basis of the documents submitted. If the health condition of the insured person so requires, the treating doctor may authorise the transport by private car, rental vehicle or taxi. Such transport must be approved in advance by a revision physician. In that case, the cost of kilometres travelled shall be borne by a flat-rate insurance company.
(4) For comprehensive spa care [(§ 27 (3) (a))], which is provided as a necessary part of the treatment process as recommended by the doctor, the health insurance company shall pay travel expenses. If the age or state of health of the insured person so requires, the health insurance company shall also pay the transport costs of the guide.
(5) Indicated transport of doctors and other health workers to an insured person is covered by the health insurance company according to the list of performance.
(6) In the cases indicated, a revision physician may authorise payment in excess of the previous provisions if the indication is supported by relevant expert findings.
Emergency and rescue services
The health care needs also include:
(a) acute health care provided outside the office hours of practical and dental practitioners by first-aid medical services or by practical and dental doctors for their registered insured persons;
(b) medical care provided by the emergency services of pharmacies;
(c) performance performed by the medical emergency services (16) in the provision of professional pre-hospital emergency care.
Assessment activities
The necessary health care also includes the assessment of temporary incapacity to work by a treating doctor and the assessment of the facts which, under Section 127 of the Labour Code, are important personal obstacles to work.
CONDITIONS FOR PROVISION OF THE RELIEF
Forms of the contract
A contract concluded by a health insurance undertaking with a healthcare establishment shall include:
(a) the type and extent of medical care needed to be provided to insured persons;
(b) the manner and extent of the implementation of payments, including their dates;
(c) the method of replacement or transitional payment mechanisms;
(d) the way in which information is exchanged between the health care establishment and the health insurance undertaking and its scope;
(e) the way in which the obligations arising from the contract are secured.
Provision of the necessary health care
The health care required is provided mainly in health care institutions, but also in the insured person's apartment or in another place where care needs to be provided, healthcare professionals, 7) or other health professionals, if necessary, to the extent of their professional competence. Medical professionals other than doctors provide the necessary medical care based on the doctor's office. The requirement of a previous doctor's practice does not apply to middle healthworkers (8) and rescue workers in cases where the necessary care is urgent, as well as clinical psychologists with regard to acute mental crises and traumas.
Refusal of custody
The chosen doctor may refuse to receive the insured person into his or her care only if his or her acceptance would exceed the workload of the doctor in such a way that he or she would not be able to provide good health care for this or the other insured persons in his or her care. Another serious cause for which the chosen doctor may refuse to accept the insured person is also the excessive distance between the place of permanent or temporary residence of the insured person for the performance of the visiting service. The degree of workload and the severity of the cause for not taking care of the insured person shall be assessed by the chosen physician. A doctor may not refuse an insured person from a specified area of employment. 17)
Outpatient care
(1) Basic comprehensive health care is provided by their practitioner to the insured. This doctor means a doctor for adults and a doctor for children and adolescents.
(2) On taking custody, the practitioner shall complete the registration form, the copy of which shall be sent to the competent health insurance undertaking. At the same time, he will require medical documentation from a doctor who had taken care of the insured person during the previous period. This physician must pass the dossier on to the physician.
(3) The practitioner shall be obliged to provide care for the insured person in his custody, including the visiting service for those insured persons, at the place indicated on the registration sheet.
Paragraph 17 (2) shall also apply to dental and female doctors where they provide basic care in their field.
(1) Insurers who are repeatedly or long-term resident in a place different from the place of permanent residence are entitled to choose a practical, dental and female doctor available at that place. Insurers may choose this doctor with the warning of the need for only temporary care and the choice of doctor already made at the place of residence.
(2) A doctor for whom a transitional choice is made has the right to request an extract from the health file of the insured person. This doctor sends an extract from the health file of the insured person to the doctor for whom the basic choice is made after the completion of the transitional care.
(1) If the health status of the insured person requires the provision of professional care, the practitioner shall recommend to the insured the contractual medical establishment which is capable of providing professional care at the appropriate level; This is without prejudice to the right to choose a doctor and healthcare facility (9). The medical practitioner shall also send written reasons and relevant medical data, including the results of prior examinations and information on the treatment carried out, together with a recommendation for admission by a specialist.
(2) In the cases indicated, the treating physician shall arrange for the examination or treatment of the insured person in the recommended medical institution; This also applies to the arrangement of constitutional care. The training agreement does not apply to cases where the insured person is sent to a medical establishment. 10)
(3) The medical practitioner or another health professional shall inform the practitioner, where appropriate, if the nature of the disease so requires, also the medical practitioner who has custody of the insured person, of the facts identified, and of the course and termination of the treatment, in particular those relevant to the assessment of medical fitness and the epidemiological situation. The same applies to the provision of information between a general practitioner and a doctor of preventive care racing.
(1) There is also a special form of outpatient care provided as domestic health care, healthcare in sanitariums (stationary care institutions) and in social care institutions.
(2) Domestic care and care in social care institutions provides health care needed in their own social environment to insured persons with acute or chronic illness, to insured persons with physical or mental disabilities and to dependent on foreign aid.
(3) Sanitary care includes the carrying out of diagnostic and therapeutic performance in insured persons whose medical condition requires care without the need for hospitalisation. The health insurance company shall cover the healthcare provided and part of the overheads of the insured's residence corresponding to the share of the health care provided in the sanatorium.
Constitutional care
If the health status of the insured person so requires, he shall be provided with the necessary health care in the form of constitutional care. Constitutional care means care in hospitals and in professional medical institutions. In these establishments, insured persons may be investigated and treated for bed or outpatient treatment.
(1) Insurers are usually admitted to institutional care on the advice of the treating physician. The treating physician shall also send written reasons and relevant health data, including the results of prior examinations and information on the treatment carried out, with a recommendation for admission to constitutional care. Insurers are admitted to professional medical institutions on the basis of a proposal from the treating physician; This condition may not be met when admitted to a psychiatric hospital.
(2) An insurer must be admitted to constitutional care if the postponement would endanger his or her life or seriously threaten his or her health and if the birth is involved. Acceptance shall also not be denied in the case of compulsory treatment. 11)
(3) Any non-admission of an insured person to constitutional care shall be duly documented. In this case the insured person shall be given a message to the treating physician. The same shall apply if the insured person himself refuses to accept.
(1) If necessary due to the health of the child, the guide may also be admitted to constitutional care. The stay of a guide to a child under 6 years of age in a hospital is considered as a constitutional treatment. In the case of a child older than 6 years of age, the stay of the guide in the hospital shall be considered as a constitutional treatment only with the consent of the revised physician.
(2) The guide may also be accepted to the hospital in cases other than those referred to in paragraph 1. Such residence is not considered as a constitutional treatment and is not covered by a health insurance company.
(3) In the case of complex spa care, the stay of the guide shall be considered as a constitutional treatment only if the guide of a child under 6 years of age is admitted to a specialised spa hospital for the period when he is trained in the care and rehabilitation of the child. In other cases, in the case of complex spa care for children and adults [(§ 27 (3) (a))], the insurance company shall only pay for the stay of the guide if the necessary treatment is confirmed by the medical examiner.
(1) An immediate care of the insured person is provided by a team of health professionals led by a nursing doctor of a hospital or medical institution, which determines the diagnostic and therapeutic procedure within the framework of the instructions of the head doctor of the department. In order to ensure professional care and synergy of experts of different disciplines, individual consiliary services for hospitalized insured persons are provided.
(2) If the insured person is required to be transferred to another department, the transfer must be consulted in advance with the head doctor of the ward or his authorised doctor.
(3) For medical reasons, the insured person may be temporarily released for home treatment. For the duration of the pass, the health care institution shall not be entitled to charge the cost of institutional care to the health insurance company except for the medicines and means by which the insured person is provided with the pass.
(1) The insured person shall be released from institutional care as soon as the necessary examinations and treatments are carried out or if there is such improvement in the state of health where further care can be provided on an outpatient basis or in other health institutions, or in social care facilities, as appropriate. The insured person must be equipped with medicines and means for the necessary period of time.
(2) The insured person will be released early from constitutional care at his own written request (reverse), unless it is possible to carry out investigative and medical procedures without the consent of the patient. 12)
(3) An insurer who consistently violates the rule of law in a gross manner and refuses to cooperate in a substantial manner may be released early from institutional care if such behaviour is not due to a serious mental disorder or other serious reasons and if the immediate interruption of care would not be jeopardised in a serious manner of his health. The insured person may not be released early in cases of compulsory treatment.
(4) A report on the release of the insured person, including a proposal for a further treatment procedure, shall be sent to treating physicians without delay.
(5) If the insured person is unable to do so without the assistance of another person due to his or her medical condition, he or she may be released from constitutional care only after prior timely notification of the family member or the person who is able to provide such care.
(6) The district office of Prague, the district office of the district office, according to the place of residence of the insured person, is informed of the release of the insured person who is not provided with further care. Similarly, children and adolescents with serious social problems in the family are treated the same way. The costs incurred by the further hospitalisation of the insured person, which cannot be discharged due to the failure to provide further care, are not borne by the health insurance company.
Spa care
(1) Spa care provided as a necessary part of the treatment process is proposed by the treating physician, confirmed by the medical examiner and paid by the health insurance company. The proposal for spa care is submitted on a pre-printed form of a health insurance company. At the same time, the degree of urgency [paragraph 3 (a)] is determined.
(2) Diseases for which spa care is provided to insured persons, indication conditions, duration of treatment stay, type of spa care and list of spa places of the Czech Republic where the spa care is provided are set out in the Annex to this Regulation ("Indicative list").
(3) Spa care is provided and paid as:
a) comprehensive spa care - this care is based on institutional care or care in professional ambulances and is aimed at healing, preventing disability and inadequacy or minimising the extent of disability. It is provided at a time of temporary incapacity to work. The insured person is summoned to the spa care spa hospital. In the first order of urgency, the patient is summoned to the treatment no later than one month after the date of issue of the proposal, or after agreement of the nursing, revision and spa doctor, transferred to the hospital directly from the hospital bed. In the second order of urgency, the patient is summoned no later than three months, children and youth within six months of the date of issue of the proposal. The costs of complex spa care are fully covered by the health insurance company;
(b) health care allowance - this treatment is provided for diseases included in the Indicative List and where the conditions referred to in (a) are not met. The health insurance company shall cover the costs of the examination and treatment of the insured person. This care may be provided once every two years, unless the medical examiner decides otherwise.
(4) Children and adolescents under 19 years of age shall be provided spa care as referred to in paragraph 3 (a) unless it is provided at the request of the parents in accordance with paragraph 3 (b).
(5) In the case of accidents at work, occupational diseases and other damage to health from work, spa care shall be provided in accordance with paragraph 3 (a) if it has been designed or indicated by the competent professional for occupational diseases.
(6) The method of providing the spa care referred to in paragraph 3 shall be proposed by the treating physician and approved by the revised physician according to the Indicative List. According to paragraph 3 (a), spa care may also be provided on the basis of a proposal from a treating physician other than those provided for in the Indicative List, provided that the indication is supported by an appropriate expert finding.
If the insured person considers that he is not receiving adequate medical care, he may:
(a) submit a proposal for a review to the head of the medical institution, 14)
(b) contact the Czech Medical Chamber, the Czech Dental Chamber or the Czech Pharmacy Chamber, if they concern shortcomings in the professional or ethical procedure of a doctor or pharmacist, or any other professional organisation, if they have been established, if they relate to those deficiencies of another healthcare professional;
(c) contact the medical examiner, in particular if there is a refusal of health care.
PROVISIONS COMMON, TRANSITIONAL AND FINAL
To the same extent as for contractual health care establishments, the health insurance company shall pay urgent care, in particular first aid, for therapeutic interventions in situations where there is a risk of delay, imminent life or serious harm to health, provided by a healthcare institution which is not under contract with the health insurance company.
For the purposes of this Regulation, a health insurance undertaking shall: General health insurance company of the Czech Republic or other health insurance company carrying out general health insurance, if any.
Control
(1) Revision practitioners and health professionals competent for the review activities designated by the health insurance undertaking (hereinafter referred to as "professionals") check that:
(a) the extent of the care provided corresponds to the amount of care charged to the health insurance undertaking;
(b) only the performance, medicines and means which the health insurance undertaking is obliged to pay have been charged;
(c) the extent and type of health care corresponds to the health status of the insured person.
(2) In order to fulfil the tasks referred to in paragraph 1, medical practitioners and experts shall be entitled to enter a medical establishment. The performance of the activities of the revised physician and professional staff shall not interfere with the therapeutic performance performed.
The medical institution shall provide the health insurance undertaking with the necessary synergies in the performance of the check, in particular providing the required documents, communicating the data and providing explanations. Access to medical documentation shall be granted only to medical practitioners or professionals; such personnel shall have access to medical documentation only to the extent appropriate to the inspection.
Emergency health care payment
(1) In exceptional cases, the health insurance undertaking shall pay as specific items:
(a) healthcare which is particularly expensive, identified in the performance list or in the list of medicines and devices in this way;
(b) health care, the provision of which, in terms of the health status of the insured person, is the only possibility of health care, otherwise by the health insurance company not necessarily covered.
(2) Special items are prescribed for valid forms indicating the character of the special item.
(3) Except where there is a risk of delay, prescribing a specific entry is bound to the prior approval of the revision physician. The health insurance company shall pay the special items in full or with the financial contribution of the insured person.
(1) The care provided in long-term sick hospitals, nursing care, children's homes, nurseries, health care centres, professional medical institutions for children and youth in regional competence is covered by the budget of the founder. The employer's budget shall also cover the medical emergency services (16) and emergency services, except for the necessary medical care provided under Section 12.
(2) The provision of paragraph 1 shall be without prejudice to the obligation on citizens to pay medical compensation under specific rules.
(1) Medical products and devices prescribed by doctors of the contractual medical facilities of the Czech Republic, which are provided in the medical care facilities of the Slovak Republic in 1992, are covered by the health insurance company.
(2) Medical products and devices prescribed by doctors of medical facilities of the Slovak Republic, which are provided in the Czech Republic's medical care facilities in 1992, are not covered by the health insurance company.
The resources provided by the Czech State Budget in 1992 to the advance payment during each quarter of the General Health Insurance Corporation of the Czech Republic shall be settled with the State Budget on the basis of the payments actually paid for the necessary health care provided at the dates of settlement of these subsidies with the State Budget.
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Regulation Information
| Citation | Full text of Act No. 117 / 1993 Coll., Decree of the Government of the Czech Republic, which publishes the Health Regulations and implements certain provisions of the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance (as is apparent from subsequent amendments and additions) |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 15.04.1993 |
|---|---|
| Effective from | - |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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