Decree No. 125 / 2018 Coll.
Ordinance on the information contained in the health plan and outlook and how it is to be submitted by health insurance companies
Valid
Effective from 29.06.2018
125
DECLARATION
of 13 June 2018
on the information provided in the health plan and outlook and on how to submit them to health insurance companies
The Ministry of Health and the Ministry of Finance provides for the Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by Act No. 24 / 2017 Coll., (hereinafter "Act No. 551 / 1991 Coll. ') and under the Act No. 280 / 1992 Coll. (hereinafter" Act No. 280 / 1992 Coll.'):
Submission of a disability plan and outlook
The general health insurance company of the Czech Republic and the department, branch, business and other health insurance companies (hereinafter referred to as the "health insurance company") transmit the health insurance plan and outlook to the Ministry of Health and the Ministry of Finance in electronic form via the data box in an open and machine-readable format.
Background to the disability plan and outlook
The health insurance plan and the outlook are based in particular on the legislation in force at the time of their transmission to the Ministry of Health and the Ministry of Finance and on macroeconomic predictions relating to the periods for which the health insurance plan and outlook are processed. This legislation and the sources of predictions shall be indicated by the health insurance company in the health insurance plan.
Health insurance plan
Data on the health insurance undertaking included in the health plan shall include:
(a) the name and code of the health insurance undertaking and its registered office;
(b) the organisational structure of the health insurance undertaking and the expected changes in the period covered by the health insurance plan;
c) Intent to develop the information system pursuant to § 24 of Act No. 551 / 1991 Coll. and § 21 of Act No. 280 / 1991 Coll.
An overview of the activities of the health insurance undertaking shall be given by the health insurance undertaking in the structure set out in Annex 1 to this Regulation.
(1) The information on the creation and use of resources of the basic health insurance fund and the breakdown of the income and expenditure of the basic health insurance fund, including the calculation of their total balance, shall be provided by the health insurance undertaking in the structure referred to in Annex 2 to this Decision.
(2) Data on the creation and use of the resources of the operational fund and the breakdown of the revenue and expenditure of the operational fund shall be entered by the health insurance undertaking in the structure set out in Annex 3 to this Regulation. Part of the health insurance plan is the calculation of the maximum limit on the cost of own activity under the legislation governing the income and expenditure of public health insurance funds (1).
(3) Data on the creation and use of the resources of the assets of the General Health Insurance Corporation of the Czech Republic and of the reproductions of capital assets of departmental, business, corporate and other health insurance companies and the breakdown of income and expenditure of the reproductions of assets of the General Health Insurance Agency of the Czech Republic and of the reproductions of capital assets of departmental, branch, corporate and other health insurance companies shall be entered by the health insurance undertaking in the structure referred to in Annex 4 to this Regulation. The health insurance plan shall include information on the investment intentions of the health insurance undertaking, including their justification.
(4) Data on the production and use of the resources of the social fund and the breakdown of the income and expenditure of the social fund shall be entered by the health insurance undertaking in the structure set out in Annex 5 to this Regulation.
(5) The data on the creation and use of resources of the reserve fund and the breakdown of revenue and expenditure of the reserve fund will be provided by the health insurance undertaking in the structure set out in Annex 6 to this Decision.
(6) Data on the generation and use of resources of the Fund shall be entered by the health insurance undertaking in the structure set out in Annex 7 to this Regulation. The health insurance company shall provide an overview of the programmes covered by the prevention fund, including the costs in the structure referred to in Annex 14 to this Decree.
Where a health insurance undertaking carries out an activity other than that of public health insurance, it shall indicate the breakdown of the revenues and costs of such an activity in the structure referred to in Annex 8 to this Decree. The health insurance plan shall include information on the own investment instruments.
(1) Furthermore, the Military Health Insurance Corporation shall provide information on the creation and use of the resources of the Fund for Preventive Care provided in addition to the services paid for for in-service soldiers and students of military education 2) and the breakdown of the revenue and expenditure of that Fund in the structure referred to in Annex 9 to this Decree.
(2) The Military Health Insurance Corporation shall provide data on the drawing-up of the resources of the Fund to facilitate the payment of health services paid by the Ministry of Defence (3) and the breakdown of the revenue and expenditure of the Fund in the structure referred to in Annex 10 to this Decree.
(3) If the Military Health Insurance Corporation plans to make an exceptional allocation to the Operational Fund4), it will indicate this in the health insurance plan.
(1) The health insurance company shall indicate the expected costs of the covered health services in the structure set out in Annex 11 to this Decree. The health insurance plan shall include a justification for the planned increase or decrease in costs for any type or form of health services. If such a change is higher than 5% compared to the calendar year preceding the year for which the disability plan is submitted and if such change does not result directly from other legislation on the basis of which the disability plan is drawn up, in particular from the legislation governing the determination of the value of the point, the amount of the payments of the services paid and the regulatory limit (5), the health insurance undertaking shall state the reasons for the change and the health service providers concerned.
(2) The health insurance company shall indicate the expected cost of the health services covered, in conversion to 1 insured person in the structure referred to in Annex 12 to this Decree.
(3) The health insurance company shall provide information on the development of the costs of the treatment of insured persons from other Member States of the European Union, the European Economic Area or the Swiss Confederation in accordance with the directly applicable provisions of the European Union governing the coordination of social security systems (6) and those of other States with which the Czech Republic has concluded international social security agreements covering the area covered by the service (7) (hereinafter referred to as the "foreign insured person ') in the structure set out in Annex 13 to this Regulation.
The health insurance plan also includes information on:
(a) the particulars contained in Annexes 1 to 14 to this Decree;
(b) the priorities of the health insurance undertaking's revision and control system for at least the period for which the health insurance plan is drawn up;
(c) the methods, the determination of the amount and the regulatory limits applied for reimbursement of individual types or forms of health services covered;
(d) subsidiaries and legal entities engaged in the business of a health insurance undertaking;
(e) control and recovery of premiums, including fines, periodic penalty payments and premiums;
(f) the objectives of the development of the insurance family, including measures to stabilise it;
(g) the intentions of the health insurance contract policy and the presumption of the availability of the services covered; and
(h) other matters which the health insurance undertaking considers to be relevant for the performance of public health insurance.
View
(1) The view contains revenue and expenditure.
(2) The health insurance undertaking shall, in the perspective, indicate in the structure set out in Annex 15 to this Regulation:
(a) total revenue;
(b) insurance against public health insurance after reallocation 8),
(c) total expenditure;
(d) expenditure on health services from the basic health insurance fund (9);
(e) own expenditure;
(f) a balance of total revenue and expenditure;
(g) total balances on accounts at the end of the current period;
(h) balances on the accounts of the basic health insurance fund at the end of the current period;
(i) any obligations of the health insurance undertaking at the end of the current period;
(j) any claims of the health insurance undertaking at the end of the current period.
(1) The outlook also includes a description of the expected development of the health insurance undertaking's management in the years to which the outlook is processed, containing at least information on:
(a) the development of total revenue;
(b) expected health insurance premiums after redistribution;
(c) the development of overall expenditure, including the assumption of developments in contract policy and operational activities;
(d) planned investment projects; and
(e) the development of the overall balance; where the health insurance undertaking envisages a negative balance of income and expenditure for the period for which the outlook is drawn up, the health insurance undertaking shall indicate the planned economic stabilisation measures.
(2) The description shall also include information on the development of the total and the balances of the basic health insurance fund on accounts at the end of the current period.
(3) Part of the description is also information on
(a) the development of all commitments, commitments to health service providers and commitments to other entities and their maturity; and
(b) the development of all claims, claims for premium payers, claims for health service providers and other claims and their maturity.
Further part of the view is
(a) a final summary of the expected economic development of the health insurance undertaking in the years to which the outlook is processed; and
(b) a summary of the most significant effects which will or may have an impact on the management of the health insurance undertaking.
Efficacy
This Decision shall enter into force on 29 June 2018.
Minister for Health:
Mgr. et Mgr. Vojtěch v. r.
Minister of Finance:
JUDr. Schiller, Ph.D., v. r.
Příloha č. 1
Annex No 1 to Decree No. 125 / 2018 Coll.
Overview of the activity of the health insurance undertaking
Příloha č. 2
Annex No 2 to Decree No. 125 / 2018 Coll.
Basic Health Insurance Fund (in thousand CZK)
Calculation of income and cost balance for ZFZP (in thousand CZK)
from selected items of parts A III and B II of ZFZP
Příloha č. 3
Annex No. 3 to Decree No. 125 / 2018 Coll.
Operating Fund (1000 CZK)
Příloha č. 4
Annex No 4 to Decree No. 125 / 2018 Coll.
Fund for the Reproduction of Assets of the All-Obencé Health Insurance Corporation of the Czech Republic and Fund for the Reproduction of Investment Assets of Occupational Health Insurance Companies (hereinafter referred to as the "Fund for Reproduction of Property") (in tis CZK)
Příloha č. 5
Annex No 5 to Decree No. 125 / 2018 Coll.
Social Fund (1000 CZK)
Příloha č. 6
Annex No 6 to Decree No. 125 / 2018 Coll.
Reserve fund (in thousand CZK)
Příloha č. 7
Annex No 7 to Decree No. 125 / 2018 Coll.
Prevention Fund (1000 CZK)
Příloha č. 8
Annex No 8 to Decree No. 125 / 2018 Coll.
Activities other than public health insurance (hereinafter referred to as "other activities") (in CZK thousand)
Příloha č. 9
Annex No 9 to Decree No. 125 / 2018 Coll.
Fund for Preventive Care (1000 CZK)
Příloha č. 10
Annex No. 10 to Decree No. 125 / 2018 Coll.
Fund for intermediate payments of health services (in thousand CZK)
Příloha č. 11
Annex No 11 to Decree No. 125 / 2018 Coll.
Structure of costs for health services by segment (in thousand CZK)
Příloha č. 12
Annex No 12 to Decree No. 125 / 2018 Coll.
Structure of costs for health services by segment in conversion to 1 insured person (in CZK)
Příloha č. 13
Annex No. 13 to Decree No. 125 / 2018 Coll.
Development of costs of treating foreign insured persons in the Czech Republic
Příloha č. 14
Annex No 14 to Decree No. 125 / 2018 Coll.
Preventive health care costs drawn from the prevention fund (in thousand CZK)
Příloha č. 15
Annex No 15 to Decree No. 125 / 2018 Coll.
Medium-term health insurance (1000 CZK)
1) Paragraph 7 (2) of Decree No 418 / 2003 Coll., which provides for a more detailed definition of the heading and amount of the income and expenditure of public health insurance funds of health insurance companies, the conditions for their creation, use, admissibility of transfers of funds between them and their management, the limit of the cost of the activities of health insurance companies covered by the resources of the basic fund, including the procedure for calculating this limit, as amended.
2) Article 16 (3) of Act No. 280 / 1992 Coll., as amended.
3) Article 16 (2) of Act No. 280 / 1992 Coll., as amended.
4) Paragraph 1 (4) (m) of Decree No. 418 / 2003 Coll., as amended.
5) For example, Decree No 353 / 2017 Coll., on establishing the values of the point, the amount of compensation paid for services and regulatory restrictions for 2018.
(6) Regulation (EC) No 883 / 2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, as amended. Regulation (EC) No 987 / 2009 of the European Parliament and of the Council of 16 September 2009 laying down detailed rules for the application of Regulation (EC) No 883 / 2004 on the coordination of social security systems. Regulation (EU) No 1231 / 2010 of the European Parliament and of the Council of 24 November 2010 extending the scope of Regulation (EC) No 883 / 2004 and Regulation (EC) No 987 / 2009 to third-country nationals not yet covered by these Regulations solely on grounds of their nationality.
7) For example, the Communication of the Ministry of Foreign Affairs No. 130 / 2002 Coll. on the Agreement between the Czech Republic and the Federal Republic of Yugoslavia on Social Security, the Communication of the Ministry of Foreign Affairs No. 135 / 2004 Coll. s., on the Agreement of the Treaty between the Czech Republic and the Republic of Turkey on Social Security, the Communication of the Ministry of Foreign Affairs No. 2 / 2007 Coll. s., on the Agreement of the Treaty between the Czech Republic and the Republic of Macedonia on Social Security.
8) Sections 20 and 21a of Act No. 592 / 1992 Coll., on Insurance against Public Health Insurance, as amended. § 1 (1) (a) and (b) of Decree No. 418 / 2003 Coll., as amended.
9) Paragraph 1 (4) (a), (b) and (d) of Decree No. 418 / 2003 Coll., as amended.
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Regulation Information
| Citation | Decree No. 125 / 2018 Coll., on the information contained in the health plan and outlook and on how to submit them to health insurance companies |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 22.06.2018 |
|---|---|
| Effective from | 29.06.2018 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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