Act No. 438 / 2004 Coll.
Act amending Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended, Act No. 592 / 1992 Coll., on Insurance against General Health Insurance, as amended, and Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended
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Effective from 01.08.2004
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438
THE LAW
of 24 June 2004
amending Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended, Act No. 592 / 1992 Coll., on Insurance against General Health Insurance, as amended, and Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended
Parliament has decided on this law of the Czech Republic:
Amendment of the Act on the General Health Insurance Company of the Czech Republic
Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by Act No. 592 / 1992 Coll., Act No. 10 / 1993 Coll., Act No. 60 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll., Act No. 305 / 1997 Coll., Act No. 93 / 1998 Coll., Act No. 127 / 1998 Coll., Act No. 69 / 2000 Coll., Act No. 132 / 2000 Coll., Act No. 220 / 2000 Coll., Act No. 49 / 2002 Coll., Act No. 420 / 2003 Coll., and Act No. 455 / 2003 Coll., is amended as follows:
1. in Article 6 (7), including footnotes (3a) and (3b):
"(7) The proceeds of fines, premiums and periodic penalty payments imposed under the special legislation governing public health insurance (3a) and accepted by the insurance undertaking during the calendar year may be allocated by the insurance undertaking to the prevention fund; Such allocations to the prevention fund may be made in advance during the calendar year so that their total amount per calendar year does not exceed 0,3% of the total amount of insurance premiums after reallocation under the General Health Insurance Act. (3b)
3a) Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended. Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended.
3b) Act No. 592 / 1992 Coll., as amended. '
2. in Article 7 (1) (a):
"(a) the basic fund; the source of the basic fund is the payment of public health insurance premiums and other income to the extent provided for in the implementing legislation. The basic health insurance fund shall be used for the payment of public health care, the allocation to the operational fund to cover the cost of the insurance business, the allocation to other funds and other payments to the extent provided for in the implementing legislation, '.
3. in the first sentence of Article 7 (1) (b), the words "reserve fund. The minimum reserve amount shall be 3% 'shall be replaced by" the reserve fund; the reserve amount shall be 1,5%'.
4. in Article 7 (1) (e) and (f):
"(e) the asset fund,
(f) the reproductions fund. ";
5. in Article 7 (2) (b), including footnote 9:
"(b) the prevention fund; from the prevention fund, health care may be paid in excess of that covered by public health insurance under special legislation, 9) with a demonstrable preventive, diagnostic or therapeutic effect, provided that it is provided to insured persons in connection with their existing or imminent illness. The resources of the prevention fund can also be used to implement preventive health programmes to detect serious diseases, to promote rehabilitation and rehabilitation activities leading to a demonstrable improvement in the health status of the participants, and to support projects promoting improved health care quality, healthy life and health of insured persons. The resources of the Fund shall be funds from the share of the result of the post-tax management provided by the statutory bodies of the Insurance Corporation for activities which, in addition to the implementation of public health insurance, the Insurance Company shall carry out in accordance with the laws and regulations of the Insurance Corporation and the funds referred to in Article 6 (7).
9) Paragraph 13 (2) of Act No. 48 / 1997 Coll., as amended. '
6. In the first sentence of Article 7 (4), the words "tangible and intangible investment assets (10) 'are replaced by the words" tangible and intangible assets'.
footnote 10 is deleted.
7. Paragraph 7 (5) reads as follows:
"(5) The funds of the Insurance Corporation must be deposited in a bank benefiting from a single licence under the law of the European Communities."
footnote 4 is deleted;
8. In Paragraph 8 (1), the words "measures published in the Collection of Laws' are replaced by" implementing legislation '.
9.
(1) The organisational structure of the Insurance Company is composed of the Central Office, regional branches (usually one regional branch for a higher local authority) and other territorial offices. Regional branches and territorial offices are the organisational components of the Insurance Company, which act and carry on business on behalf of the Insurance Company.
(2) The Organisation of the Institute, as well as the designation, organisation, location, territorial scope and tasks of regional branches and territorial offices, shall lay down the rules of organisation of the Insurance Corporation. ';
10.
Headquarters
(1) The Centre shall manage the activities of the Organisational Components of the Insurance Corporation.
(2) The Centre shall implement the decisions of the Management Board, decide on the activities of the Insurance Corporation, ensure synergies with the public authorities, other public administrations, legal and natural persons and other activities related to the implementation of public health insurance. "
11.
Directors
(1) The statutory body of the Insurance Company is the Director of the Insurance Company, elected by the Board of Directors of the Insurance Corporation and dismissed by Parliament's Chamber of Deputies on a proposal from the Board of Directors of Insurance.
(2) The head of the Regional Branch is the Director appointed and removed by the Director of the Insurance Corporation. '
12. Sections 15 and 16 shall be deleted, including the headings.
13. The heading of Part Four reads: "Insurance institutions."
14.
(1) Insurance authorities are the Management Board and the Supervisory Board.
(2) Through the institutions The insurance undertaking shall be provided with the participation of insured persons of the insurance undertaking, the employers of the insured person and the State in the management of the insurance undertaking. '.
15. in Article 18 (1), (2) and (4), the words "or the County Insurance Authority" shall be deleted;
16. in Paragraph 18 (2), the words "or County Insurance Corporation" shall be deleted;
17. in Paragraph 18 (3):
"(3) A member of the Management Board may not be a member of the Supervisory Board at the same time and vice versa. A member of the Management Board may not be a member of the Supervisory Board even in the four-year term of office following the end of his or her membership of the Management Board; This also applies to a member of the Supervisory Board in the case of his membership of the Board of Directors. '
18. in Article 18 (5) and (6):
"(5) Member of the institution Insurance undertakings may perform the same function again in no more than two consecutive functional periods.
(6) A member of the Insurance Authority does not perform his duties in employment relations with Insurance. Member of the institution Insurance undertakings shall be entitled to reimbursement of the expenses associated with the performance of their duties and may be remunerated at the rate specified in the sickness plan. ';
19. in Paragraph 18 (7), the words "and the authorities of the District Insurance Corporation" shall be deleted;
20. Article 19 shall be deleted, including the title.
21. In Section 20, the words "Central Insurance 'are deleted.
22. in Paragraph 20 (1):
"(1) The Management Board shall decide:
(a) approval of the insurance undertaking's organisation rules;
(b) approval of the insurance plan, accounts and annual reports;
(c) the approval of the volume of payments to healthcare establishments;
(d) change in the value of the point;
(e) approval of the principles of contract policy;
(f) claims by the Insurance Corporation for credit;
(g) purchase of real estate;
h) purchase of tangible capital goods at a cost exceeding CZK 1 000 000;
(i) taking over the guarantee obligation;
(j) the use of resources of the reserve fund;
(k) other important matters relating to the insurance undertaking's activities and which it reserves to decide. ';
23. in Article 20 (2), the word "insurance undertakings" shall be inserted after the word "insured persons."
24. In Paragraph 20, the following sentences are added at the end of paragraph 2: "If all the representatives of the State present, all the representatives of the insured persons present or all the representatives of the employers of the insured persons present at the meeting of the Management Board object that the proposed decision of the Management Board may jeopardise the financial balance of the public health insurance system or the balanced management of the insurance undertaking, the Management Board shall not adopt the decision and fix a time limit which may not exceed 3 months for the submission of supplementary documents confirming or refuting the objection. No later than 30 days after the expiry of the deadline laid down for the submission of supplementary documents, the Management Board shall renegotiate the proposed decision; at least two-thirds of all members of the Management Board shall be required to take such a decision. The examination of objections shall not jeopardise the fulfilment of the legal obligations of the insurance undertaking. '
25. in Article 20 (6), the word "insurance undertakings" shall be inserted after the word "insurance undertakings" and after the word "elects" the words "from among the public and shall be deleted."
26. in Paragraph 20 (7):
"(7) The representatives of the employers of insured persons shall appoint and withdraw employers' organisations to the Administrative Board. ';
27. In Section 21, the word "Insurance 'is deleted.
28. In the first sentence of Article 21 (1), the words "Insurance undertakings' are deleted and in the second sentence the words" Insurance institutions' are replaced by the words "Management Board '.
29. in Article 21 (2) and (3):
"(2) The Supervisory Board shall discuss the draft health insurance plan, the financial statements and the draft annual report and submit its opinion to the Joint Management Board and the Supervisory Board.
(3) The Supervisory Board shall consist of:
(a) 3 representatives of the State from which the Ministry of Finance, the Ministry of Labour and Social Affairs and the Ministry of Health are appointed and withdrawn,
(b) 3 representatives of insurance insurers elected and withdrawn by the Chamber of Deputies of Parliament,
(c) 3 representatives of employers of insured persons appointed and withdrawn by the employer's organisation;
(d) one representative of the insurance company's insured persons for each regional branch elected and withdrawn by the Regional Council; and
(e) one representative of the employers of the insured persons for each regional branch elected and withdrawn by the employer's organisation. ';
30. In Paragraph 21, paragraphs 4 to 6 are deleted.
Article 31 (22), including the title, reads:
Joint meetings of the Management Board and the Supervisory Board
(1) The Joint Management Board and the Supervisory Board are convened to discuss the draft health insurance plan, the accounts and the draft annual report of the Insurance Corporation. The Joint Meeting shall consist of all the members of the Management Board, the members of the Supervisory Board and the Director of the Insurance Corporation.
(2) A joint meeting of the Management Board and the Supervisory Board shall be convened by the Director of the Insurance Company within a sufficient time limit before the submission of the disability plan, the accounts and the draft annual report to the Insurance Authority. '
32. Article 23 shall be deleted, including the title.
33.Paragraph 24 (1) reads as follows:
"(1) The insurance undertaking shall manage, update and develop the insurance information system."
34. in the first sentence of Article 24a (1), the words "or District Insurance Corporation" are deleted and in the second sentence the words "or District Insurance Company" are deleted.
35. in § 24c, the words "district insurance undertaking" are replaced by the words "regional branch or relevant territorial establishment" and the words "is obliged" are replaced by the words "are obliged."
Transitional provisions
1. The Supervisory Board must be supplemented by representatives of insured persons and employers of insured persons for each regional branch within 6 months of the date of application of this Act; for a period of 6 months from the date of application of this Act, only members of the Supervisory Board of the Insurance Company elected and appointed according to the current regulations shall be acting as Supervisory Board.
2. The insurance company is obliged to bring its organizational order into line with Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by this Act, within 6 months of the date of entry into force of this Act.
3. The funds of the reserve fund exceeding the amount of the reserve fund provided for by Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by this Act, shall be transferred to the basic fund within 15 days of the date of the entry into force of this Act.
Amendment of the Act on departmental, branch, corporate and other health insurance companies
Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended by Act No. 10 / 1993 Coll., Act No. 15 / 1993 Coll., Act No. 60 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll., Act No. 93 / 1998 Coll., Act No. 127 / 1998 Coll., Act No. 225 / 1999 Coll., Act No. 220 / 2000 Coll., Act No. 49 / 2002 Coll. and Act No. 420 / 2003 Coll., is amended as follows:
1. In the first sentence of Paragraph 7 (1), "30 'is replaced by" 60'.
2. In the third sentence of Paragraph 7 (1), the words "measures published in the Collection of Laws' are replaced by" implementing legislation '.
3. Paragraph 10 (1) reads as follows:
"(1) The bodies of the employee insurance undertaking shall be the Management Board and the Supervisory Board. The Management Board of the Employee Insurance Corporation shall decide on:
(a) approval of the insurance plan, accounts and annual reports;
(b) the approval of the volume of payments to medical establishments;
(c) a change in the value of the point;
(d) approval of the principles of contract policy;
(e) applications for credit from an occupational insurance undertaking;
(f) purchase of real estate;
g) purchase of tangible capital goods at a cost exceeding CZK 1 000 000,
(h) taking over the guarantee obligation;
(i) use of the reserve fund;
(j) other important matters relating to the activities of the occupational insurance undertaking and which they reserve for decision making. ";
4. In Paragraph 10, the following paragraph 2 is inserted after paragraph 1:
"(2) The insured persons, the employers of the insured persons and the State are represented in the institutions of the employee insurance company by one third each. If all the representatives of the State present, all the representatives of the insured persons present or all the representatives of the employers of the insured persons present at the meeting of the Management Board object that the proposed decision of the Management Board may jeopardise the financial balance of the public health insurance system or the balanced management of the occupational insurance undertaking, the Management Board shall not adopt the decision and shall set a time limit which may not exceed 3 months for the submission of additional documents confirming or refuting the objection. No later than 30 days after the expiry of the deadline laid down for the submission of supplementary documents, the Management Board shall renegotiate the proposed decision; at least two-thirds of all members of the Management Board shall be required to take such a decision. The examination of objections shall not jeopardise compliance with the legal obligations of the occupational health insurance undertaking. ';
Paragraphs 2 to 4 shall become paragraphs 3 to 5.
5. Paragraph 15 (2) and (3) reads as follows:
"(2) The Employee Insurance Corporation shall submit to the Ministry of Finance, through the Ministry of Health, a draft health insurance plan for the following calendar year, financial statements and an annual report for the last calendar year and an auditor's report, following the deadlines set by the Ministry of Finance for the submission of the draft State Budget and the State Final Account. 12)
(3) The draft health insurance plan, the accounts and the annual report referred to in paragraph 2 of this Article shall be approved by the Chamber of Deputies of Parliament following the dates of the consideration of the draft State budget and the State Final Account, following the observations of the Government. The approved annual report shall be published by the employee insurance undertaking in an appropriate manner. ';
6. In Article 15, the following paragraph 4 is inserted after paragraph 3:
"(4) If the health insurance plan of the occupational insurance undertaking is not approved before 1 January of the relevant calendar year, the activity of the occupational insurance undertaking shall be governed by a commission established by the Ministry of Finance until the health insurance plan has been approved. The proposal for a health insurance plan for the relevant calendar year shall be the basis for establishing a commission. ';
Paragraph 4 shall become paragraph 5.
7. in Article 16 (4) (b), including footnote 17,
'(b) the prevention fund. The prevention fund may cover healthcare in excess of that covered by public health insurance under a specific legislation, 17) where there is evidence of a preventive, diagnostic or therapeutic effect and which is provided to insured persons in connection with their existing or imminent illness. The Fund's resources can be used to implement preventive health programmes to detect serious diseases, to promote rehabilitation and rehabilitation activities leading to a demonstrable improvement in the health status of the participants, and to support projects promoting improved health care quality, healthy life and health of insured persons. The resources of the Fund shall be funds from the proportion of positive economic result after tax provided by the statutory body of the occupational insurance undertaking for activities carried out by the occupational insurance undertaking in accordance with the laws and regulations of the occupational insurance undertaking and the revenue referred to in Article 19 (1) in addition to the performance of public health insurance,
17) Paragraph 13 (2) of Act No. 48 / 1997 Coll., as amended. "
8. Paragraph 17 (1) reads as follows:
"(1) The basic health insurance fund is used for the payment of public health care, for the allocation to the operational fund to cover the cost of the activities of the occupational insurance company, for the allocation of additional funds and for other payments to the extent provided for in the implementing legislation. The source of the basic fund shall be payments of public health insurance premiums and other income to the extent provided for in the implementing legislation. ';
9. In the first sentence of Paragraph 18 (1), the words "Minimum levels' are replaced by the words" Amount 'and the words "3%' are replaced by the words" 1,5% '.
10.Paragraph 19 (1) reads as follows:
"(1) The funds generated by the use of the basic fund by the occupational insurance undertaking and the revenue resulting from fines, premiums and periodic penalty payments charged by that insurance undertaking in the field of public health insurance may be used by the occupational insurance undertaking as a source of the prevention fund only where the reserve fund is filled and managed in a balanced manner. ';
11. in Paragraph 19 (2):
"(2) The funds of the employee insurance undertaking must be deposited in a bank enjoying the benefit of a single licence under the law of the European Communities. '
Transitional provision
The funds of the reserve fund pursuant to Article 18 of the Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll., which at the date of entry into force of this Act exceed the amount of the reserve fund provided for by this Act, shall be transferred by the employee insurance company to the basic fund within 15 days of the date of entry into force of the Act.
Amendment to the General Health Insurance Insurance Act
Act No. 592 / 1992 Coll., on Insurance against General Health Insurance, as amended by Act No. 10 / 1993 Coll., Act No. 15 / 1993 Coll., Act No. 161 / 1993 Coll., Act No. 324 / 1993 Coll., Act No. 42 / 1994 Coll., Act No. 241 / 1994 Coll., Act No. 59 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll., Act No. 48 / 1997 Coll., Act No. 53 / 2004 Coll., Act No. 49 / 2002 Coll., Act No. 176 / 2002 Coll.
1. in Paragraph 3 (5) (b), the words "or 8" shall be deleted;
2. Paragraph 3 (7) is deleted.
Paragraphs 8 to 14 shall become paragraphs 7 to 13.
3. in Article 3 (7), the following point (e) is added:
"(e) under which the insurance company is a payer (§ 3c),"
4. In Article 3 (8) (c), "paragraph 8 'is replaced by" paragraph 7'.
5. In Article 3 (10), "paragraphs 1 to 9 'is replaced by" paragraphs 1 to 8';
6. Paragraph 3a (3) is deleted.
Paragraphs 4 and 5 shall be renumbered paragraphs 3 and 4.
7. In Article 3a (3), in the introductory part of the sentence, the words "further 'are deleted and in point (a), the words" § 3 (8)' are replaced by the words "§ 3 (7) '.
8. in Article 3a (3), the following point (c) is added:
"(c) under which the insurance company is a payer (§ 3c),"
9. In Article 3a (4) (c), the words "or 4 'are deleted.
10. In Article 13, the second sentence is deleted.
11. in the second sentence of Article 20 (1), the words "multiplied by the age structure of the insured persons" shall be replaced by the words "their age structure, gender and cost indices of the age groups of the public health insurers."
12. In Paragraph 20, the following paragraphs 2 and 3 are inserted after paragraph 1:
"(2) For the redistribution of premiums, the cost indices of 18 age groups of insured persons for each sex shall be used between birth and 5 years, from 5 to 10 years, and thereafter after 5 years to age groups from 80 to 85 years and groups from 85 years. The table of age groups and their definition are annexed to this law.
(3) The cost indices shall be determined as a proportion of the average cost of the insured person in the group by age and sex and of the average cost of the standardised insured person. The average cost of insured persons in the group by age and sex shall be determined by the administrator of the account as the average cost of all health insurance companies for all insured persons in the group by age and sex. The average cost of a standardised insured person shall be determined by the administrator of the account as the average cost of all health insurance companies for women aged 15-20 years. Data from the last closed calendar year shall be used to determine the cost indices according to the first and average cost theorems according to the second and third sentences. In order to do this, all health insurance undertakings are required to communicate to the account administrator the number of insured persons in each age category by sex and the total cost of insured persons in those categories by age. '
Paragraphs 2 to 4 shall be renumbered paragraphs 4 to 6.
13. in Paragraph 20 (6):
"(6) The rules on the management of the special account, including additional corrections, details for the application of the claim under Section 21a, methodology for calculating the average costs referred to in paragraph 3, cost indices of age groups including the valuation and allocation of costs to those groups and the average cost per insured person under Section 21a (2), rules of procedure of the supervisory authority and cost indices for the relevant calendar year shall be issued by the Ministry of Health by a decree in agreement with the Ministry of Finance. ';
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Regulation Information
| Citation | Act No. 438 / 2004 Coll., amending Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act No. 280 / 1992 Coll., on departmental, occupational, corporate and other health insurance companies, as amended, Act No. 592 / 1992 Coll., on Insurance against General Health Insurance, as amended, and Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended |
|---|---|
| Regulation Type | Law |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 26.07.2004 |
|---|---|
| Effective from | 01.08.2004 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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