Act No. 161 / 1993 Coll.
Law on changes in general health insurance and on amendments and additions to certain other laws
Valid
Effective from 01.07.1993
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161
THE LAW
of 19 May 1993
on changes in general health insurance and on changes and additions to certain other laws
Parliament has decided on this law of the Czech Republic:
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., the Act of the Czech National Council No. 10 / 1993 Coll. and the Act of the Czech National Council No. 15 / 1993 Coll., is amended as follows:
1.
Purpose of the law
This Act provides for general health insurance (hereinafter referred to as "health insurance"), on the basis of which health care is provided wholly or partly covered by health insurance to the extent provided for by this Act and the Health Regulations. '
2. In Section 2 and paragraphs 1 and 4, the words "required health care 'are replaced by the words" fully or partly covered health care'; in Sections 2 (2), 10 (1) (g), 13 (1) and (2), 14 (1) and 19 (2), the words "required health care 'are replaced by the words" fully or partially covered health care'; in Article 15 (2), the words "necessary health care 'are replaced by the words" full or partly paid health insurance';
3. In the last sentence of Paragraph 2 (3), "Ministry 'is replaced by" Ministry of Health ("Ministry') '.
4.
Personal extent of health insurance
(1) Under this law they are insured by:
(a) persons resident in the Czech Republic;
(b) persons who are in working or similar relationship to an employer who is established in the Czech Republic, even if they are not resident in the Czech Republic.
(2) For the purposes of this Act, the registered office of the employer shall be the registered office of the legal person and the registered office of his or her organisational unit and the place of residence of the natural person, if any, of his or her place of residence and, where applicable, of his or her business.
(3) Health insurance under this Act excludes persons who are not resident in the Czech Republic and who are active in the Czech Republic for employers who enjoy diplomatic benefits and immunities, or for employers who are not established in the Czech Republic, and persons who are long-term resident abroad and who are not insured (§ 7 (5)). "
5. In Section 4, the words "(a) and (b) 'are deleted.
6.
Establishment and termination of health insurance
(1) Health insurance is established by:
(a) by birth, if it is a permanent resident in the Czech Republic,
(b) the date on which the employer has his registered office in the Czech Republic takes up work or similar relationship;
(c) obtaining permanent residence in the Czech Republic.
(2) Health insurance shall cease:
(a) the death of the insured person or his declaration of death;
(b) the termination of an employment or similar relationship in the territory of the Czech Republic, except as regards the insured persons referred to in § 3 (1) (a);
(c) termination of permanent residence on the territory of the Czech Republic, except as regards the insured persons referred to in § 3 (1) (b). "
7. In Paragraph 6 (2), the words "citizenship of the Czech and Slovak Federal Republic 'are deleted and the words" unless the State is the paying of the premium under paragraph 4' are replaced by the words "unless otherwise specified '.
8. In Paragraph 6 (2), the last sentence shall read: "In addition to workers in employment, the following shall be regarded as having a working or similar relationship:
(a) workers working in a ratio which has the content of an employment relationship but is not so marked or does not have all the formalities required for the employment relationship;
(b) workers working under an agreement on work activities;
(c) members of cooperatives, if they are not in employment relations with the cooperative but are engaged in the work for which they are remunerated;
(d) members of limited liability companies and commanditists of a limited liability company, if they are not in employment relations with that company but are engaged in the work for which they are remunerated;
(e) Members of the legislature,
(f) members of municipal councils acting as long-term vacant members of the municipal council,
(g) members of the Government and heads of the other central authorities of the Czech Republic,
(h) Judges,
(i) prosecutors,
j) President, Vice-President and members of the Presidium Board of the Supreme Audit Office of the Czech Republic,
(k) professional soldiers, members of the Police of the Czech Republic, members of the Prison Service of the Czech Republic and members of other armed security forces and security services,
(l) internal scientific aspirants,
(m) volunteer care staff,
(n) foster care in special establishments;
(o) persons in prison,
(p) persons with altered working capacity preparing for employment;
if they are involved in sickness insurance (insurance) under the sickness insurance (insurance) rules. ';
9. In Paragraph 6 (3), the following words are added at the end of the first sentence: "and, with the exception of persons on leave without compensation of income, where such persons prove that another employer or other organisation for which they are active at that time is the payer and persons who are acting under Paragraph 7 (4) '.
10. Article 6 (4) (a) to (e) and (g) and (h) read:
"(a) unprovided children, 4)
(b) pensioner of pension pension under special law, 4a)
(c) recipient of the parental allowance, 5)
(d) persons on maternity leave and other maternity leave and men during their absence at work for whom they are granted financial assistance under sickness insurance legislation;
(e) jobseekers (6) including jobseekers working on community service;
(g) persons who are primarily or completely helpless and who are caring for a predominantly or completely helpless person, 8) or a long-term disabled child, 8a)
(h) persons engaged in basic (replacement) service in the armed forces or civil service and persons (soldiers in reserve) called for military training, ';
11. footnote 4 (a):
"4a) § 7 (a) of Act No. 100 / 1988 Coll. '.
12. Notes 8 and 8a are as follows:
"8) Paragraph 36 (2) and (3) of Decree No. 149 / 1988 Coll.
8 (a) Paragraph 37 (1) of Decree No. 149 / 1988 Coll. '
13. Article 6 (4) (k) and (l) read:
"(k) persons who have reached the age required for entitlement to an old-age pension but who do not fulfil the additional conditions for his or her entitlement to an old-age pension and do not have income from employment, self-employment, capital, rental or other income under the Income Tax Act or do not benefit from a foreign pension, or if the amount of income and income from a foreign pension does not exceed a monthly amount of a minimum wage, 8b)
(l) persons personally and properly caring for at least one child under the age of seven or at least two children under the age of 15, not the persons referred to in (d), and only one person shall be regarded as such, either the father or mother of the child or the person who has taken the child into permanent care of the parents; (c) the condition of full-time childcare shall be deemed to have been met, even if the person has income from employment, business, other self-employment, capital goods, hire or other income under the Income Tax Act, which, after deduction of the expenses incurred to achieve them, reinsurance and maintenance, does not exceed a monthly amount of 77% of the minimum wage. "
14. Notes No 8b and No 8c are as follows:
"8b) § 2 (1) (b) of Decree of the Government of the Czech Republic No. 53 / 1992 Coll., on minimum wage.
8c) § 2 (3) of Act No. 382 / 1990 Coll., on Parental Contributions. '.
15. Article 6 (5) reads as follows:
"(5) Where persons referred to in points (a) to (j) of paragraph 4 have income from employment, from business, from other self-employed activities, from capital goods, from leasing or other income under the Income Tax Act, the insurance company shall also be the payer of the insurance company. ';
16. In Section 7, the following paragraph 4 is added:
"(4) The insured person is not obliged to pay insurance premiums for the period when he is long abroad and is insured abroad. In such a case, for the duration of insurance abroad and the non-payment of insurance premiums to the relevant health insurance undertaking, the insured person shall not be entitled to full or partial care covered by health insurance under this Act. Such a fact shall be recorded in writing with the relevant health insurance undertaking. A continuous stay of more than six months shall be considered as a long-term stay abroad. If the insured person has been granted leave of absence of income for long-term residence abroad by the employer, neither the employer nor the employee shall be obliged to pay the insurance during that period if it is referred to in the first sentence. ';
17. in the last sentence of Paragraph 8 (3), the words "unpaid leave" shall be replaced by the words "leave of absence without income compensation" and the following sentence shall be added at the end: "In the absence of an employee at work, the staff member shall be obliged to pay the employer the amount corresponding to the insurance premium which the employer has paid for the staff member for that period."
Paragraph 18 (9) (3) reads as follows:
"(3) An insurer for whom a health insurance has been incurred pursuant to Article 5 (1) (c) or a health insurance has ceased to exist under Article 5 (2) (c) shall be obliged to register or cancel with the relevant health insurance undertaking no later than eight days after the date on which the health insurance was created or disappeared."
19. The first sentence of Paragraph 10 (2) reads: "Soldiers in active duty, with the exception of soldiers in reserve called for military training and pupils in military schools who prepare for the service of an occupational soldier and are not in active service, are insured with the Military Health Insurance Agency."
20. Paragraph 13 (4) reads as follows:
"(4) The health insurance undertaking concerned shall pay on the basis of:
(a) a medical prescription issued by a contractual health care institution, a doctor providing first aid to an insured person, a doctor providing health care in a social care institution and a doctor providing medical care to himself, his husband, his parents, his grandparents, children, grandchildren and siblings, provided that his expertise is guaranteed by the Czech Chamber of Medicine or the Czech Chamber of Dentistry, and that he concludes a special contract with the health insurance company
1. medical care facilities for medicinal products and medical devices with the exception of medical devices referred to in point 2;
2. to other contracting entities, glasses and eye optics, hair substitutes, orthopaedic prosthetic devices in series and individually manufactured, compensation aids for disabled persons, including carriages and lifting aids for immobile persons, and hearing aids, blind and weak-sighted,
3. medical care facilities and other apparatus used for therapy,
(b) the account submitted to the contractual health service
1. dental prosthetics and therapeutic rehabilitation aids,
2. orthodontic apparatus,
3. service interventions on the funds provided,
the list of medicinal products and medical devices indicating the amount of the payments made by the relevant health insurance companies. ';
21. Paragraph 13 shall be added to paragraphs 5 and 6 as follows:
"(5) The list of medicinal products and medical devices is prepared by the Ministry following a prior conciliation procedure with the Czech Pharmacy Chamber, the Insurance Office and representatives of health insurance companies; the parties to the proceedings shall be convened by the Ministry at least once a year. A list of medicines and medical devices, its changes and additions, is issued by the Ministry by a decree.
(6) If the prescriber prescribes a medicine or a medical device to which the insured person is involved according to the list of medicines and medical devices, he shall inform the insured person accordingly. However, if the medical condition of the patient is required in accordance with the recommendation of the treating physician, made in agreement with the medical examiner of the relevant health insurance undertaking, the health insurance company shall pay fully the prescribed medicines or medical devices, and, exceptionally, the medicines in the list of medicines and medical devices not listed. ';
22. Paragraph 18 (1) reads as follows:
"(1) The general rules on administrative procedures shall apply to decisions of health insurance undertakings relating to the payment of premiums, fines, periodic penalty payments and premiums. Health insurance companies shall decide by means of payment, which shall be enforceable under the rules on civil proceedings. The appeal shall be decided by the arbitration body of the health insurance undertaking. ';
Paragraph 18 (3), (4) and (5) shall be renumbered paragraphs 2, 3 and 4.
24. In Article 18 (4), the words "as referred to in paragraph 1 'shall be inserted after the words" insurance undertakings'.
25. § 20a reads:
(1) The health insurance undertaking concerned shall have the right to compensation against third parties if it has incurred the cost of care fully or partly covered by health insurance as a result of their alleged infringement against persons participating in health insurance. This compensation is the income of health insurance funds.
(2) For the purposes of compensation, health care establishments shall notify the relevant health insurance undertaking of accidents and other damage to the health of the persons to whom they have provided health care, provided that they have reasonable grounds to suspect that the accident or other damage to health was caused by the conduct of a legal or natural person. The authorities of the Police of the Czech Republic, prosecutors and courts are also required to notify. '
26. The following Section 20b is inserted after Section 20a:
Undependent children as referred to in Article 6 (4) (a) shall be deemed to have been provided until 31 December 1998 by students aged over 26. '
The Act of the Czech National Council No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by the Act of the Czech National Council No. 10 / 1993 Coll. and the Act of the Czech National Council No. 15 / 1993 Coll., is amended as follows:
1. Paragraph 3 (1) reads as follows:
"(1) The assessment basis for a person having an employment relationship or an equivalent relationship (hereinafter referred to as" employee ') shall be the sum of the income charged to him by the employer or, where applicable, the employer in connection with the performance of the employment which constitutes a participation in sickness insurance (insurance), with the exception of non-deductible income which is:
(a) several2a) provided at termination and severance pay, 2b)
(b) performance of loyalty or stability, if any, 2c)
(c) reimbursement of expenses paid to staff in connection with employment, 3)
(d) compensation, 4)
(e) remuneration paid under the Act on inventions, designs and improvements, 4a)
(f) in-kind benefits, with the exception of in-kind wages, and other similar transactions, and, where appropriate, financial compensation for non-paid benefits;
(g) reimbursement of wages 2g) in the performance of the armed forces and civil service. ';
(2) Notes 2) and 6) shall be deleted.
(3) Notes (2a) to (2c) are as follows:
"2a) Act No. 195 / 1991 Coll., on severance grants granted at termination of employment. Section 5 of Decree No. 19 / 1991 of the Federal Ministry of Labour and Social Affairs Coll., on the labour application and physical security of workers in mining for a long period of time unfit for work.
2b) E.g. § 14 of the ČNR Act No. 186 / 1992 Coll., on the service ratio of members of the Police of the Czech Republic.
2c) For example, Act No. 62 / 1983 Coll., on Loyalty Admission of Miners, Decree of the Ministry of Labour and Social Affairs of the Czech Republic and Ministry of Agriculture and Nutrition of the Czech Republic No. 62 / 1970 Coll., on the provision of recruitment allowances and other benefits to residents in the defined territory of the border, as amended by Decree No. 69 / 1986 Coll. '
4. footnote 4 is replaced by the following:
"(4) § 187 to 206 of the Labour Code. '
5. footnote 4 (a):
"(4a) Act No. 527 / 1990 Coll., on inventions, designs and improvements. '
6.
"(2) The minimum assessment basis for a staff member shall be the minimum wage of workers in employment remunerated by monthly salary (hereinafter referred to as" minimum wage '), 7) with the exception of staff with severe physical, sensory or mental disabilities, providing exceptional benefits of grade II or III under social security rules, 8) where the assessment basis is always the income actually obtained. If the employee is the person for whom the payer is a State, 9) the basis of assessment is an amount exceeding 77% of the minimum wage; Paragraph 6 shall remain unaffected. Unless otherwise specified, the assessment basis for the period during which the staff member was granted leave of absence of income, 10) or when he had an unexcused absence at work, is his average earnings for employment purposes. 9) at the time when he was granted leave of absence of income compensation, no insurance is paid. In addition, insurance shall not be paid for the period during which the staff member was granted leave of absence of income compensation, unless it lasted more than three calendar days in the calendar month for which the insurance is paid. In the case of a worker to whom the employer has granted leave of absence of income compensation and who carries out a public office or another employer's work, the obligation to pay the premium (Section 5) shall pass to the body for which the public office or employment is performed. For the period when staff members were granted leave for important personal obstacles to work11) except maternity leave, additional maternity leave and the absence of a man at work for the period during which they receive cash assistance under sickness insurance legislation, insurance shall not be paid. Where the staff member's assessment base (paragraph 1) is lower than the minimum assessment basis, the staff member shall be obliged to pay back to the health insurance undertaking through his employer or, where appropriate, through one of his employers chosen, an premium of 13,5% of the difference between those bases; where the basis of assessment is lower due to obstacles on the part of the organisation, 11a) the difference is due to the employer.';
7. footnote No 11a:
"11a) § 129 and 130 of the Labour Code. '.
8. footnote 7:
"7) § 2 (1) (b) of Decree of the Government of the Czech Republic No. 53 / 1992 Coll., on minimum wage."
9. In Paragraph 3 (3), the word "at least 'is deleted and the amount" 45%' is replaced by "35% 'and the amount" 540 000 CZK' is replaced by "CZK 486 000 '.
10. In the last sentence of Paragraph 3 (3): "If the coexistence of activities under Paragraph 13 is not the main source of income, the basis of assessment is the actual income calculated in accordance with the first sentence; the maximum measurement basis is unchanged. ';
(11) Notes 12 to 14) are as follows:
"12) § 7 (3) of the ČNR Act No. 586 / 1992 Coll., on Income Tax.
13) § 12 of the ČNR Act No. 586 / 1992 Coll.
14) Paragraph 13 (1) and (3) of Act No. 586 / 1992 Coll. '
12.
"(4) The assessment basis for a person who has income from capital goods, rental income or other income under the Income Tax Act (" the person with own income ') 15) and who does not have income from a work or similar relationship or from business or other self-employed activity is 35% of that income, with the exception of income from which the tax is levied at a special rate of 16) or exempt from income tax, 17) less the expenses incurred in achieving, securing and maintaining them. The minimum assessment basis shall be 12 times the minimum wage; the maximum measurement base is CZK 486 000. (9) If the person for whom the insurance State is the payee has the income referred to in the first sentence, the assessment basis shall be 35% of the amount exceeding, after deduction of the expenditure incurred to achieve, secure and maintain the income, 12 times that of the minimum wage; the provisions of paragraph 6 shall remain unaffected.';
13. Notes 15 to 17) are as follows:
"15) Sections 8, 9 and 10 of Act No. 586 / 1992 Coll., as amended by Act No. 157 / 1993 Coll.
16) § 36 of the ČNR Act No. 586 / 1992 Coll., as amended by Act No. 157 / 1993 Coll.
17) § 4 of Act No. 586 / 1992 Coll., as amended by Act No. 157 / 1993 Coll.
14. In Article 3, the following paragraph 7 is added:
"(7) Where persons referred to in paragraphs 2, 3 and 4 have income for a shorter period than the applicable period referred to in Article 4, the monthly assessment basis shall be reduced to a proportion corresponding to the number of calendar days and the annual assessment basis to a proportion corresponding to the number of calendar months to which such revenue relates. For persons without taxable income, the assessment basis shall be reduced to a proportion corresponding to the number of calendar days in the relevant period. In the case of persons for whom an insurance claim is a State, the deduction of premiums paid by the State shall be treated mutatis mutandis. ';
15. in Article 4 (1), the words "for which insurance is payable" shall be inserted after the words "the month."
16. in Article 4 (2), the words "the preceding calendar year" shall be replaced by the words "the calendar year for which insurance is paid."
17. in the sentence of Article 4 (3), the first words of the "three immediately preceding calendar years" shall be replaced by "the last three calendar years, including the calendar year for which the premium is paid," and in the sentence of the second sentence, the words "the previous calendar year" shall be replaced by "the calendar year for which the premium is paid."
18. in Paragraph 5 (2), the fourth and fifth sentences are deleted.
19. In Article 7, the following paragraph 1 is added:
"(1) Self-employed persons shall pay premiums in the form of advances on premiums and premiums, unless otherwise specified. Where further provisions refer to insurance premiums, this shall also mean advances on premiums and premiums. ';
20. In Section 7, the current text is referred to as paragraph 2 and the following sentences are added at the end: "Insurance advances shall not be paid for the calendar months in which the self-employed person has been recognised as unable to work or has been ordered to quarantine under the rules on measures against communicable diseases for the entire calendar month. In the cases referred to in the previous sentence, the advance paid shall be settled on subsequent payment of the advance. ';
21. In Paragraph 8, paragraph 3 is renumbered paragraph 4, and at the same time the word "date 'is replaced by" within eight days after'.
22. in Article 8, the following paragraph 3 is added:
"(3) At the request of a self-employed person, for a maximum period of three months, the health insurance undertaking concerned shall reduce proportionally the amount of the premium payment where the income of the self-employed person from the self-employed person from the self-employed activity after deduction of the expenditure incurred for the achievement, reinsurance and retention of the self-employed person for an average of one calendar month in a period of at least three calendar months consecutive in the calendar year in which the insurance advance is paid is at least one third of the amount of such income corresponding to an average of one calendar month in the previous year. If, during the three calendar months following the reduction of the advance, the self-employed person finds that the amount of the advance is no longer in line with the revenue actually obtained, he shall be obliged to increase the advance. '
23. Article 8 shall be added to the following paragraph 5:
"(5) If the sum of the premiums paid for the relevant period is higher than the premiums provided for in Article 2 (1), the premium shall be overpaid (§ 14). '
24.
Insurance premiums for persons with own income
(1) Persons with their own income pay premiums in the form of advances on premiums and premiums, unless otherwise specified. Where insurance premiums are mentioned in other provisions, this also means advances on premiums and premiums.
(2) A person with his own income shall pay monthly advances on premiums calculated from the minimum assessment base referred to in Article 3 (4) on behalf of the relevant health insurance undertaking unless he or she provides for higher advances by the 20th day of the preceding calendar month. In the month in which the person became liable to pay the premium, 24) the advance on the premiums payable within eight days of the date on which the obligation arose. Within eight days of the occurrence of this obligation, the advance on premiums shall be payable for the following calendar month if the last day of payment of the advance for the calendar month in which the obligation to pay the premium arose falls on the 21st day or the following days of that month.
(3) For the following year, monthly advances shall be calculated on the basis of the assessment for the previous calendar year.
(4) At the request of a person with his own income, for a maximum period of three months, the competent health insurance undertaking shall reduce proportionally the amount of the insurance advance where the income of the person with his own income after deduction of expenditure incurred in attaining it, reinsurance and retention 15), covering on average one calendar month in at least three calendar months in succession in the calendar year in which the insurance advance is paid, is at least one third of the amount of such income corresponding to an average of one calendar month in the preceding calendar year. If, during the three calendar months following the reduction of the advance, a person with his own income finds that the amount of the advance is no longer in line with the revenue actually obtained, he shall be obliged to increase the advance.
(3) The supplement to the difference between advances and the actual amount of premiums calculated in accordance with Paragraph 3 (4) shall be payable within eight days of the tax return for the previous calendar year.
(6) If the sum of the premiums paid for the relevant period is higher than the premiums provided for in Article 2 (1), the premium shall be overpaid (§ 14). '
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Regulation Information
| Citation | Act No. 161 / 1993 Coll., on Changes in General Health Insurance and on Changes and Addition to Certain Other Laws |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 22.06.1993 |
|---|---|
| Effective from | 01.07.1993 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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