Act No. 369 / 2011 Coll.
Act amending Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, and certain other laws
Valid
Law
Effective from 01.04.2012
Text versions:
01.04.2012
06.12.2011
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369
THE LAW
of 6 November 2011
amending Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, and certain other laws
Parliament has decided on this law of the Czech Republic:
Amendment to the Public Health Insurance Act
Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006 / EC, Act No. 2006 / 2006, Act No. 2006 / 2006, Act No. 2006 / 2006 / 2006, Act No. 2006 / 2006, Act No. 2006 / 2006, Act No. 2006 / 2006 / 2006 / 2006, Act No. 2006 / 2006 / 2006 / 2006, Act No. 2006 / 2006, Act No. 2006 / 2006 / 2006, Act No. 2006 / 2006 Coll.
1. In Article 1 (b), the words "health care is provided under this Act 'are replaced by the words" health insurance services are covered under this Act ("services covered') '.
2. In Article 1, the current text becomes paragraph 1 and the following paragraph 2 is added, including footnote 49:
"(2) This law shall apply unless the European Union provisions directly applicable in the field of the coordination of social security schemes other than 49).
49) For example, Regulation (EC) No 883 / 2004 of the European Parliament and of the Council on the coordination of social security systems, as amended by Regulation (EC) No 988 / 2009 of the European Parliament and of the Council and Commission Regulation (EU) No 1244 / 2010, Regulation (EC) No 987 / 2009 of the European Parliament and of the Council laying down detailed rules for the application of Regulation (EC) No 883 / 2004 and Regulation (EC) No 987 / 2009 on the coordination of social security systems, as amended by Commission Regulation (EU) No 1244 / 2010, Regulation (EU) No 1231 / 2010 of the European Parliament and of the Council extending the scope of 5 April 2011 on the free movement of workers within the Union. '
3. In Article 7 (1) (d), the words "persons on 'are inserted after the words" maternity and'.
4. In Article 8 (1) (f) (2), the words "no health care covered by health insurance 'are replaced by the words" no services paid'.
5. In the third sentence of Paragraph 8 (4), the words "reimbursement of medical care 'are replaced by the words" provision of services covered'.
6. in Article 11 (1) (a) to (d):
"(a) the choice of health insurance undertakings, unless otherwise provided for in this law. The health insurance undertaking may be changed every 12 months only on 1 January of the following calendar year; the application is submitted by the insured person or his legal representative to the selected health insurance undertaking no later than 6 months before the required change date. An application for a change to the health insurance undertaking on 1 January of the calendar year may be submitted only one; any further applications shall no longer be taken into account, even if submitted within the time limit set. From the date of entry into liquidation of the health insurance company or from the date of introduction of compulsory management of the health insurance company, or from the date on which the Ministry of Health, on the basis of a finding of an imbalance in the management of the health insurance company (19), declares in the media, insured persons of such health insurance undertaking shall be entitled to change the health insurance undertaking even within a shorter period, on the first day of the calendar month, but not before the first day of the following calendar month. The change of health insurance undertaking shall be carried out by their legal representative for minors and persons who are not fit to act. When the child is born, the right to choose a health insurance undertaking shall not apply. On the day of birth, the child becomes insured by a health insurance company with which the child's mother is insured on the day of birth. A change in the child's health insurance scheme may be made by his legal representative only after the birth number has been assigned to the child on the date specified in this provision. If the insured person or the legal representative of the insured person requests the health insurance undertaking in accordance with this provision, the health insurance undertaking shall comply with his application without delay. The health insurance undertaking shall not be entitled to determine the period for which the insured person will be insured or to terminate the insured person's relationship with the health insurance undertaking itself. The health insurance undertaking shall not be entitled to accept insured persons within the time limits specified in that provision,
(b) the choice of the health service provider (hereinafter referred to as the "provider") which is under contract with the relevant health insurance undertaking and the choice of the health service provider; in the case of a registrant, it may exercise that right once every 3 months;
(c) the time and local availability of paid services provided by the contracting providers of the relevant health insurance undertaking;
(d) the provision of paid services to the extent and under the conditions laid down by this law, the provider may not accept any payment from the insured person for such services; ';
7. in Paragraph 11 (1) (e), the word "establishment" is replaced by the word "provider."
8. In Article 11 (1) (f), "health care 'is replaced by" health services';
9. in Article 11 (1), the following point (g) is inserted after point (f):
"(g) to provide information from the health insurance company on services provided to him,"
Points (g) to (k) shall be renumbered as points (h) to (l).
10. in Article 11 (1) (i), the words "the medical establishment is required" shall be replaced by the words "the provider is obliged."
11. in Article 11 (1) (j), "equipment" is replaced by "provider," "equipment" is replaced by "provider," and "mandatory" is replaced by "obliged."
12. in Article 11 (1), the line at the end of point (k) is replaced by a dot and point (l) is deleted;
13. in Article 11 (2):
"(2) If the insured person is deemed not to have received paid services in accordance with this Act, he may lodge a complaint under the Health Services Act. '
(14) footnotes 22 and 23 are deleted.
15. in Paragraph 11 (3), the sentences of the second to fourth shall be deleted;
16. in Article 11 (3) (a), the words "health care provided or prescribed by a doctor or medical institution referred to in the sentence of the second and third sentences, which is partly covered" shall be replaced by the words "paid services provided by a provider provided by a specific legislation governing the employment relationship of professional soldiers which are partly covered."
17. in Article 11 (3) (b), the words "preventive care covered by health insurance" are replaced by the words "services paid for."
18. In Article 11 (5), the word "doctor 'is replaced by" provider' and the word "transport 'is replaced by" health transport'.
19. in Article 12 (d):
"(d) provide synergies in the provision of health services and control of the course of the individual treatment process and comply with the provided treatment regime;"
20. in Article 12 (h), the words "health care" are replaced by the words "health services" and the words "and medical devices" are replaced by the words "food for special medical purposes and medical devices."
21. At the end of the text in point (k), the words "if the insured person is not staying at the place of permanent residence, the competent health insurance company must also notify the address of the place of residence in the Czech Republic, where he is mostly staying (hereinafter referred to as" residence, ")."
22. in Article 12 (m), the words "health care establishments" are replaced by the words "providers."
23. in Article 12 (n), the words "medical establishments" shall be replaced by the words "providers," the words "care" shall be replaced by "services," and the words "healthcare provided and the amount of remuneration" shall be replaced by the words "health services provided and the amount of remuneration."
24. The heading of Part Five reads: "CONDITIONS FOR PROVISION OF BORDER SERVICES."
25. The heading of Section 13 reads: "Bound services."
26. In Section 13 (1) of the introductory part of the provision, the words "care provided 'are replaced by the words" services provided'.
27. in Article 13 (1) (a), the word "reply" shall be replaced by "reply," the word "hers" shall be replaced by "theirs" and the word "safe" shall be replaced by "safe."
28. in Article 13 (1) (a) and (b), the word "is" shall be replaced by the word "are."
29. in Paragraph 13 (1) (c), the word "her" shall be replaced by "their" and the word "hers" shall be replaced by "theirs."
30. Paragraph 13 (2) reads as follows:
"(2) The services covered are within the scope and under the conditions laid down by this Law:
(a) preventive, dispensational, diagnostic, medical, rehabilitation, rehabilitation, medical, medical, medical, palliative and blood, tissues and cells-related health care, in all forms of its provision under the Health Services Act;
(b) the provision of medicinal products, food for special medical purposes, medical devices and dental products;
(c) the transport of insured persons and the reimbursement of travel expenses;
(d) blood collection and collection of tissues, cells and organs intended for transplantation and the necessary handling (storage, storage, processing and testing);
(e) transport of a living donor to and from the place of collection to and from the place of supply of health care related to the collection and from that place and reimbursement of travel expenses;
(f) transport of the deceased donor to and from the place of collection;
(g) transport of tissues, cells and organs collected;
(h) inspection of deceased insured persons and autopsies, including transport;
(i) the residence of the insured person's guide to the nursing home;
(j) health care related to the pregnancy and birth of a child whose mother has requested the secrecy of her person in connection with the birth; such care shall be borne by the health insurance undertaking which, on the basis of the identification details of the insured person, shall be requested by the competent provider. ';
31. in Paragraph 13, paragraph 3 is deleted;
Paragraphs 4 to 9 shall be renumbered paragraphs 3 to 8.
32. in § 13 (3) to (8), the words "health care" are replaced by the words "health services."
33. In the first sentence of Paragraph 13 (3), the words "care referred to 'are replaced by the words" services referred to' and in the sentence the second word "such 'is replaced by" such'.
34. In Article 13 (4), the words "care which is so marked 'are replaced by the words" services which are so marked' and the words "care which 'are replaced by the words" services which'.
35. in Article 13 (5), the words "which" shall be replaced by the words "which," the words "compulsory" shall be replaced by the words "compulsory"; the words "provider" shall be replaced by the words "published in medical" shall be replaced by the words "provider published in medical premises" and the words "accessible place" shall be inserted after the words "accessible place"; the words "further."
36. In Article 13 (6) to (8), the words "Medical equipment 'are replaced by the words" Provider'.
37. In the first sentence of Article 13 (6), "6 'is replaced by" 5' and the word "mandatory 'is replaced by" obliged'.
38. In Paragraph 13 (8), "8 'is replaced by" 7'; the words "medical establishment 'are replaced by" provider'; the words "paragraph 3 'are replaced by" paragraph 2'; the word "spent 'is replaced by" spent'; and the word "prevented 'by" prevented'.
39. In Paragraph 14, the words "care provided 'are replaced by the words" services provided' and the words "necessary and urgent treatment 'are replaced by the words" urgent health care of which'.
40. In Article 15 (2), the word "further 'shall be inserted after the words" insurance'.
The introductory part of Article 15 (3) reads as follows:
"(3) The services referred to in paragraph 1 shall include health care provided on the basis of a recommendation from the registrant in the field of gyno and obstetrics in relation to artificial insemination, at most three times per life, or, in the first two cases, only one human embryo, resulting from fertilisation of the ova of sperm outside the body of the woman, has been transferred to the female's sex organs four times per life."
42. In § 15 (5), fourth sentence, § 16a (2) (b) and (f), § 16a (4) and § 22 (c), the word "constitutional" shall be replaced by "berth."
43. Paragraph 15 (6) (f) reads as follows:
"(f) which may be issued without a prescription."
44. In Article 15 (7), the words "healthcare provided 'are replaced by the words" health services provided'.
45. in Article 15 (10), the words "medical establishments" shall be replaced by "providers" and the words "providers" shall be added at the end of the text of the paragraph.
46. In the second sentence of Article 15 (14), the words "Paid-up care 'are replaced by" Paid-up services do not include' and in the third sentence, the word "performance 'is replaced by the word" services', the word "finances26 'is replaced by the word" health care' and the words "at the end of the text of the paragraph are added '; if the answer is to be paid to the authorities of the Czech Police, the supplier shall send the bill to the Ministry of Interior by the 15th day of the calendar month following the calendar month in which the services were provided'.
47. footnote 26 is deleted, including the footnote references.
48. Paragraph 15 (15) reads as follows:
"(15) Health services provided in children's homes for children under the age of 3 by health professionals who are employees of the health service provider in this health institution shall be covered by the budget of the founder. A medical rescue service shall also be paid from the budget of the body, except for the health performance referred to in Section 28. ';
49.Paragraph 16 (1) reads:
"(1) The competent health insurance undertaking shall, in exceptional cases, pay health services otherwise not paid by the health insurance company, provided that the provision of such health services is the only option in terms of the health status of the insured person. ';
50. In Paragraph 16 (2), the words "health care 'are replaced by the words" health services'.
51. in Article 16a (1), the introductory part of the provision reads:
"The insured person, or his legal representative, shall, in connection with the provision of the services to be paid, pay a regulatory fee of an amount to the provider who provided the services. '
52. In Article 16a (1) (a) (1), the words "in the case of a practitioner, a practitioner for children and adolescents, a female doctor, or in the case of a visit to a dental practitioner," shall be replaced by the words "in the case of a medical practitioner for general medical practice, practical medicine for children and youth, gyno and obstetrics, or in the case of a visit to a dental practitioner."
53.In Article 16a (1) (a) (2), the words "providing specialised outpatient care 'are replaced by the words" providing specialised outpatient care'.
54. in Article 16a (1) (a) (3):
"3. visiting service provided by the provider's doctor in the field of general practical medicine and practical medicine for children and adolescents,"
55. in Article 16a (1) (e):
"(e) CZK 90 for medical emergency or emergency services in the field of dental medicine (hereinafter referred to as the" emergency service ") on working days from 17 to 7 hours and on Saturdays, Sundays and holidays, unless this period is the regular period of office of the provider providing the emergency service; the regulatory fee for the use of emergency services shall not be paid if the insured person is subsequently admitted to bed care; ';
56. In Article 16a (1) (f), the words "constitutional care (§ 23), complex spa care or institutional care in children's professional hospitals and health care centres (§ 34)" are replaced by the words "bed care including bed spa rehabilitation care."
57. in Article 16a (3) (e), the word "provider" shall be inserted after the word "doctor."
58. in Article 16a (5), the words "the intake of a healthcare establishment" shall be replaced by the words "the receipt of the provider," the word "the choice" shall be replaced by "the choice" and the words "the medical establishment shall be required" shall be replaced by the words "the provider is obliged."
59. Paragraph 16a (6) reads as follows:
"(6) The regulatory fee referred to in points (a) to (e) of paragraph 1 shall be paid by the provider in connection with the provision of the services covered. The regulatory fee referred to in paragraph 1 (f) shall be paid by the provider no later than 8 calendar days after the end of the hospitalisation, except where the insured person is hospitalised for more than 30 days; in that case, the regulatory fee shall be paid on the last day of the calendar month. The provider shall, at his request, issue proof of payment of the regulatory fee to the insured person or his legal representative, indicating the number of the insured person, the amount of the regulatory fee, the stamp of the provider and the signature of the person who has accepted the regulatory fee and, if applicable, the name of the medicinal product or food for special medical purposes, and the amount of the supplement to be included in the limit referred to in Article 16b (1). ';
60. in Article 16a (7), the words "Medical facilities are required" shall be replaced by the words "Provider is obliged" and the words "provided health care" shall be replaced by the words "services provided."
61.In Article 16a (8), the words "Medical care facilities shall be required 'shall be replaced by the words" Medical care providers shall be obliged' and the words "limit referred to in paragraph 1 'shall be replaced by" limit referred to in Article 16b (1)';
62. In the first sentence of Paragraph 16a (9), the words "Medical equipment is required" shall be replaced by "Provider is obliged," the words "or 3" shall be replaced by "up to 4" and in the second sentence the words "medical equipment" shall be replaced by "Provider."
63.In Article 16a (10), the words "Health care establishment 'are replaced by the words" Provider', the words "paid care ', which are replaced by the words" paid services', the words "not subject 'are replaced by the words" not subject', the words "infringement of this law 'are replaced by the words" infringement of this obligation' and the words "health care establishment 'are replaced by the words" provider'.
64. in Article 16a (11), the words "health care establishments" shall be replaced by the words "providers" and the words "healthcare" shall be replaced by the words "services covered."
65. In § 16a (11), § 39a (2) (b), § 39a (3) (f), § 39b (2) (d), § 39d (1), § 39f (6) (f), "paragraph 3" is replaced by "paragraph 2."
66. In the first and second sentences of Article 16b (2), the words "deductible within the limit" shall be inserted after the words "providers."
67.In Paragraph 17 (1):
"(1) In order to ensure performance in kind in the provision of paid services to insured persons, the General Health Insurance Company of the Czech Republic and other health insurance companies established under another legislation28), contracts with providers on the provision and reimbursement of the services paid. A contract for the provision and payment of services paid may be concluded only for health services which the provider is entitled to provide. Contracts are not required when providing
(a) immediate care for the insured;
(b) health services to insured persons in the exercise of custody or in the execution of a custodial sentence or in the performance of security detention by a provider designated by the Prison Service;
(c) the health services of an insured person who is in the course of protective treatment ordered by the court, if they are health services provided in connection with a disease for which the insured person is obliged to undergo treatment. "
68. Paragraph 17 (2) is deleted.
Paragraphs 3 to 8 shall be renumbered paragraphs 2 to 7.
69. In the first sentence of Article 17 (2), the words "health care 'shall be replaced by the words" provider' and the words "health care 'shall be replaced by the words" providers'; in the second sentence, the words "healthcare services' shall be replaced by the words" provided health care 'shall be replaced by the words "provided services'; the words" provided services' shall be replaced by the words "provided services'; and the words" healthcare provision 'shall be replaced by the words "provided services';
70. In Paragraph 17 (2), the third sentence is deleted.
71.Paragraph 17 (3) reads as follows:
"(3) Providers and other entities providing paid services are required to indicate the number of insured persons to whom they have provided the paid services in the health insurance accounts."
72. In the first sentence of Paragraph 17 (5), the words "The value of the point, the amount of the health care paid by the health insurance 'are replaced by the words" Unless otherwise provided for in this Act, the value of the point, the amount of the payment of the services paid by the health care institution'; in the fifth sentence, the words "the result 'are replaced by the words" the agreement'; the words "Health care paid by the health insurance company and the regulatory limit 'are replaced by the words" The provider'.
73. In Article 17 (6), the words "health establishments' are replaced by the words" providers' and the words "establishments' are replaced by the words" providers'.
74. In Paragraph 17 (7) (a) of the introductory part of the provision, the words "medical establishments" shall be replaced by the words "providers" and the words "healthcare" shall be replaced by the words "services covered."
75. in Article 17 (7) (a) (1), the word "equipment" shall be replaced by "providers," the words "medical devices" shall be replaced by the words "medical devices" and the words "equipment" shall be replaced by "with a provider."
76. In Article 17 (7) (a) (2) and (3), "equipment" is replaced by "providers."
77.In Article 17 (7) (b), the words "medical establishments" are replaced by the words "providers."
78.In Article 17 (7) (c), the words "medical establishments' are replaced by the words" providers' and the words "medical devices' are replaced by the words" medical devices'.
79. In Article 17, at the end of paragraph 7, the dot is replaced by a comma and the following point (e) is added:
"(e) the account submitted in accordance with the implementing legislation and the price regulation of persons authorised to carry human remains under the Funeral Code, the transport of the deceased's body to and from the autopsy."
80. In Article 17, the following paragraph 8 is added:
"(8) A natural or legal person who, under the Health Services Act, has been issued a certificate of compliance with the conditions for continuing the provision of health services on the basis of the authorisation of the deceased provider shall, for 90 days from the date of issue of that certificate, be entitled to reimbursement of the health services provided to the extent resulting from the contract for the provision and reimbursement of the services paid between the deceased provider and the health insurance undertaking. ';
81. In the first sentence of Article 17a, the words "and rehabilitation health 'are deleted; the words" with residence services' are replaced by the words "providing social services'; the words" providing social services' are replaced by the words "providing services'; the words" providing services' are replaced by "providing services'; the words" providing services' are replaced by the words "providing services'; the words" providing services' are replaced by the words "providing services';
Article 82 (18), including the title, reads:
Conditions for the provision of services covered
(1) Save as otherwise provided for in this Act, medical professionals other than doctors, other than clinical psychologists, shall provide the services covered only on the basis of the indication of the treating physician of the insured person (hereinafter referred to as the "treating physician").
(2) For health insurance purposes, the treating physician means:
(a) the doctor of the registrant;
(b) the doctor of the specialist outpatient care provider,
(c) the doctor of the day care provider; or
(d) a doctor with a specialised capacity of a bed care provider. ';
Article 83 (19) to (21) shall be deleted.
84. In Section 22 of the Introductory Part of the provision, the words "Paid care 'are replaced by the words" Paid services'.
85. In Article 22 (a), the words "a registered practitioner, a registered practitioner for children and adolescents" are replaced by the words "a registered provider of outpatient care in the field of general medical practice or in the field of practical medicine for children and adolescents."
86. in Article 22 (e), the words "and rehabilitation health" shall be deleted; the words "residence" shall be inserted after the words "establishments" and the words "such establishments" shall be replaced by the words "providers of social services."
87. The heading of § 22a reads: "Special bed care."
88. In § 22a, the word "treatment" is replaced by the words "treatment is also covered services."
Article 89 (23) and (24) shall be deleted.
90. Sections 25 and 26, including the headings, read:
Stay guide to the insured person in bed care
(1) If a full-day presence of a guide is required during hospitalization of the insured person in a nursing home
(a) the health status of the insured person; or
(b) to the need to train a guide to the insured person in nursing and medical rehabilitation accompanying the insured person;
is the residence of the insured person's guide until the sixth year of age accompanied by the insured person, including the paid service; the residence of the insured person's guide over 6 years of age is paid for by the service only with the agreement of the revised physician.
(2) The residence of the guide is covered by the health insurance company with which the insured person is insured.
Insurers' facilities after hospitalization
(1) The services covered are also the equipment of the insured person for medicinal products, food for special medical purposes and medical devices after completion of hospitalisation for 3 days or, where justified, for another, strictly necessary period of time.
(2) Where the insured person is released for home treatment on leave, the provider shall not be entitled to charge the cost of bed care to the health insurance undertaking for the duration of the leave, except for medicinal products and medical devices to which the insured person shall equip the insured person for the duration of the pass. ';
(91) Paragraph 27, including footnotes 32 and 33, shall be deleted.
92. Paragraph 28, including the title, reads:
Medical and emergency services
(1) Grounded services include medical performance performed in the framework of the emergency care service.
(2) Grounded services include medical performance performed in the context of emergency services, even if urgent medical performance has been performed by a doctor outside his expertise. "
93. Paragraph 29 (1) is deleted.
Paragraphs 2 to 5 shall be renumbered paragraphs 1 to 4.
94. In Paragraph 29 (1), the introductory part of the provision reads: "Preventive inspections to be carried out are also covered by the services."
95. In Paragraph 29 (1), the words "but not earlier than 18 months after the last preventive inspection" shall be added at the end of the text of point (c).
96. In Paragraph 29 (2) of the Introductory Part of the provision, the word "dentistry 'is replaced by" dental medicine'.
97. In Paragraph 29 (3), the words "and obstetrics" shall be inserted after the word "gyno."
98. Paragraph 29 (4) is deleted.
99. In Paragraph 30 (1), "Paid care includes:" is replaced by "Paid services are" and "Paid care" is replaced by "Paid services."
100. In Article 30 (2), the introductory part of the provision reads:
"They are further reserved services."
101. In Paragraph 30 (2) (a) and (b), the word "remuneration" is replaced by "remuneration."
102.
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Regulation Information
| Citation | Act No. 369 / 2011 Coll., amending Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended, and certain other laws |
|---|---|
| Regulation Type | Law |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 06.12.2011 |
|---|---|
| Effective from | 01.04.2012 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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