Act No. 59 / 1995 Coll.
Act amending and supplementing the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as amended, Act of the Czech National Council No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended, Act of the Czech National Council No. 589 / 1992 Coll., on Social Security Insurance and Contribution to State Employment Policy, as amended, and Act of the Czech National Council No. 337 / 1992 Coll., on Tax and Charges Administration, as amended
Valid
Law
Effective from 01.05.1995
Text versions:
01.05.1995
24.04.1995
Zobrazeno prvních 200 z celkem 423 ustanovení tohoto předpisu.
Zobrazit celý předpis →
Pro stažení celého znění použijte tlačítko Stáhnout výše.
59
THE LAW
of 17 March 1995
amending and supplementing the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as amended, Act of the Czech National Council No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended, Act of the Czech National Council No. 589 / 1992 Coll., on Social Security Insurance and Contribution to State Employment Policy, as amended, and Act of the Czech National Council No. 337 / 1992 Coll., on Tax and Fees Management, as amended
Parliament has decided on this law of the Czech Republic:
Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as amended by Act of the Czech National Council No. 592 / 1992 Coll., Act of the Czech National Council No. 10 / 1993 Coll., Act of the Czech National Council No. 15 / 1993 Coll., Act No. 161 / 1993 Coll., Act No. 324 / 1993 Coll. and Act No. 241 / 1994 Coll., is amended as follows:
1.
Purpose of the law
This Act regulates general health insurance ("health insurance ') and the conditions under which health care is provided under this Act. Health care under this Act shall be provided as full or partial care covered by health insurance.'
Article 2 (2) reads as follows:
"(2) The distinction between health care referred to in paragraph 1 and care paid in full or in part shall be made taking into account the nature of the disability and the amount of financial resources to cover such care. If insured persons under the age of 18 are provided with health care marked as partially paid for in the Health Code, the health insurance company shall pay it in full. The full-paid, partially-paid and other details of care provided under this law are laid down in the Health Code. The health rules shall be binding on all health insurance undertakings carrying out health insurance. ';
3. In Paragraph 2 (3), the first sentence reads: "The Health Regulations shall be issued by the Government of the Czech Republic by a regulation following a conciliation procedure with representatives of the Ministry of Finance, the General Health Insurance Company (hereinafter referred to as the" Insurance Company "), other health insurance companies, contractual health establishments, professional organisations established by law (1) and professional scientific companies."
4. In Paragraph 2 (4), the following sentences are added after the words "therapeutic purpose 'and at the end the following sentences are added:" Health care fully or partially covered by health insurance does not include examinations, examinations and other medical procedures carried out at the request of the court, prosecutors, state administration and authorities of the Czech Police. The health performance reimbursement referred to in the previous sentence shall be provided to the health establishment by the body for which the health performance is performed, at the level specified by the list of points (§ 13 (3)) and the price statements in force.';
Note 16) reads as follows:
"16) § 3 (1) (c) of Decree of the Ministry of Health of the Czech Republic No. 467 / 1992 Coll., on health care provided for remuneration."
5. Article 3 (1) (b) reads as follows:
"(b) persons who do not reside on the territory of the Czech Republic if they are employees (§ 6a) of an employer who is established in the territory of the Czech Republic."
6. in Article 5 (1) (b) and (2) (b), the words "employment or similar relationship" shall be replaced by "employment (Article 6b (3))."
7. The heading "Health insurance payers' is inserted above Section 6.
8.
The payers of health insurance premiums (hereinafter referred to as "the premiums payers') are:
(a) the insured persons referred to in Article 6a;
(b) employers;
(c) State. ';
9. The following Sections 6a to 6c are inserted after Section 6, including Notes 3 to 12 and 17 to 22:
The insured person shall pay insurance premiums if:
(a) he shall be an employee in an employment relationship who is involved in sickness insurance. For the purposes of health insurance, the following shall be considered as staff members in employment (hereinafter referred to as "staff members'):
1. staff members shall act in a proportion which has the content of an employment relationship but which is not so designated or does not have all the formalities required for an employment relationship;
2. staff working under a work agreement;
3. members of cooperatives, if they are not in employment relations with the cooperative but are engaged in the work for which they are remunerated;
4. Associates and agents 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;
5. Members and Senators;
6. members of municipal councils who perform the function of long-term vacant members of the municipal council;
7. members of the Government and the Heads of the other Central Authorities of the Czech Republic;
8. Judges;
9. prosecutors;
10th President, Vice President and members of the Supreme Audit Office of the Czech Republic;
11. 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;
12. internal scientific aspirants;
13. volunteer care staff;
14. foster care in special facilities;
15 persons in prison;
16. Persons with altered working capacity preparing for employment,
if they are involved in sickness insurance under the sickness insurance rules,
(b) is a self-employed person. The following shall be considered as self-employed for health insurance purposes:
1. persons engaged in agricultural production, forest and water management; 17)
2. persons engaged in trade; 18)
3. persons engaged in business under special rules; 19)
4. persons engaged in artistic or other creative activities under the Law on Literary, Scientific and Artistic Works; 20)
5. members of public commercial companies and associates of limited companies; 21)
6. persons engaged in an independent profession which is not a business or a business under special rules; 22)
7. cooperating self-employed persons who, for the purposes of health insurance, are considered to be spouses and, from the end of compulsory education, the children of self-employed persons referred to in points 1 to 3, if they are engaged in their self-employed activities and are not in employment relationships,
(c) has a permanent residence on the territory of the Czech Republic, but it is not mentioned under the preceding letters and there is no payment by the insurance State (§ 6c).
(1) The employer shall pay part of the insurance premiums for his staff, except for staff members who proceed under Paragraph 7 (4).
(2) For health insurance purposes, the employer is a legal or natural person who employs employees and has a registered office or permanent residence in the Czech Republic.
(3) Employment for health insurance purposes means the pursuit of the activities referred to in Article 6a (a).
(1) The State is an insurance payee through the State Budget for the following insured persons:
(a) dependent children; 3)
(b) pensioner of pensions from pension provision, (4) who were awarded pension before 1 January 1993 under the regulations of the Czech and Slovak Federal Republic and after 31 December 1992 under the regulations of the Czech Republic;
(c) the beneficiary of the parental contribution; 5)
(d) women on maternity and other maternity leave, women receiving maternity assistance and men during their absence at work for whom they are granted cash assistance under sickness insurance rules;
(e) job seekers, including job seekers, who have accepted short-term employment; 6)
(f) persons receiving social security benefits on account of social needs; 7)
(g) persons who are primarily or completely helpless and who are looking after the person who is primarily or completely helpless, 8) or a long-term disabled child; 9)
(h) persons engaged in basic (replacement) service in the armed forces or civil service and persons called for military training;
(i) persons in custody or in the execution of a prison sentence;
(j) persons who are dependent on pensioners and who, for this reason, have been treated as the sole source of income; 10)
(k) persons who have reached the age required to qualify for an old-age pension but who do not fulfil the additional conditions for his or her entitlement to an old-age pension and who do not have income from employment, self-employment and do not receive any foreign pension, or that pension does not exceed, on a monthly basis, a minimum wage; 11)
(l) persons who, on a daily basis and duly caring for at least one child under the age of seven or at least two children under the age of 15, shall not be the persons referred to in (c) or (d). The full day care condition shall be deemed to be fulfilled if the child of the pre-school age is placed in a nursery (nursery) or similar facility for a period not exceeding four hours a day and if he / she is a child carrying out compulsory schooling, for the duration of the school visit, except in an establishment with a weekly or year-round stay. Only one person, either the father or the mother of the child, or the person who has taken the child into permanent care replacing the care of the parents, shall be regarded as such (12) unless they have income from employment or self-employment.
(2) If the persons referred to in paragraph 1 (a) to (j) have income from employment or self-employment, the State of insurance shall be the payee of such persons.
3) Article 49 (2) of Act No. 100 / 1988 Coll.
4) § 7 (a) of Act No. 100 / 1988 Coll.
5) Act No. 382 / 1990 Coll., on parental contribution.
6) Sections 7 (1) and 17 (7) of Act No. 1 / 1991 Coll., on Employment. § 3 (4) of the ČNR Act No. 482 / 1991 Coll., on social needs, as amended.
7) Paragraph 92 (5) of Act No. 100 / 1988 Coll. Act No. 482 / 1991 Coll.
8) Paragraph 36 (2) and (3) of Decree No. 149 / 1988 Coll.
9) Paragraph 37 (1) of Decree No. 149 / 1988 Coll.
10) Paragraph 54 (2) of Act No. 100 / 1988 Coll.
11) Paragraph 2 (1) (b) of Decree of the Government of the Czech Republic No 53 / 1992 Coll., on minimum wage.
12) § 2 (3) of Act No. 382 / 1990 Coll.
17) Article 12a of Act No. 105 / 1990 Coll., on the Private Business of Citizens, as amended by Act No. 219 / 1991 Coll.
18) Act No. 455 / 1991 Coll., on Business Business, as amended.
19) For example, Act No. 128 / 1990 Coll., on Advocacy, Act No. 209 / 1990 Coll., on Commercial Lawyers and Legal Assistance by them.
20) Act No. 35 / 1965 Coll., on Works of Literary, Scientific and Artistic (Copyright Act), as amended by Act No. 89 / 1990 Coll. and Act No. 468 / 1991 Coll.
21) Sections 76 and 93 of Act No. 513 / 1991 Coll., Commercial Code.
22) § 7 (2) (b) of ČNR Act No. 586 / 1992 Coll., on Income Taxes. '
10.
"(1) Insurance shall be paid to the health insurance undertaking in which the insured person is insured (hereinafter referred to as the" relevant health insurance undertaking '). The insurance obligation shall be incurred by the insured person on:
(a) taking up employment;
(b) self-employment;
(c) when he became an insured person under § 6a (c);
(d) return to the Czech Republic, if the insured person has followed § 7 (4);
(e) return to the Czech Republic after a continuous stay abroad which began before 1 January 1993, if the return date falls after 30 April 1995; the insured person is obliged to provide evidence to the relevant health insurance undertaking;
(f) return to the Czech Republic after a continuous stay abroad, which began between 1 January 1993 and 1 July 1993, if the return date falls after 30 April 1995 if the insured person:
1. has been insured abroad,
2. he has not been fully or partially covered by this Act during that period,
3. Asked retroactively the competent health insurance undertaking for the procedure laid down in Article 7 (4).
This shall be without prejudice to the obligation to pay insurance premiums for the period preceding the stay abroad. ';
11. Article 7 (2) reads as follows:
"(2) The employer's obligation to pay part of the employee's insurance premiums shall arise on the day of the staff member's recruitment, except as provided for in Section 6b (1). This obligation shall expire on the date of termination of employment. '.
12. in Article 7 (3), "Article 6 (4)" is replaced by "Article 6c."
13. Article 7 (4) reads as follows:
"(4) The insured person shall not be obliged to pay insurance premiums for the duration of his or her long-term abroad if he / she is insured abroad and has made a written declaration to that effect with the relevant health insurance undertaking. However, the obligation to pay the premium shall expire only on the date on which the insured person indicated in the declaration referred to in the first sentence, but not before the day following the date on which the declaration was delivered to the relevant health insurance undertaking. From the same date, until the date on which the insured person has re-registered with the relevant health insurance undertaking, the insured person shall not be entitled to full or partial medical care under this law. At the same time as re-registration with the relevant health insurance undertaking, the insured person shall submit to that insurance undertaking an additional proof of the insured health insurance abroad and its length. If the insured person does not submit such a document, the competent health insurance undertaking shall pay back the premiums as if it had not acted under this provision. A continuous stay of more than six months shall be considered as a long-term stay abroad. ';
14. in Article 7 (5), the words "and be entitled to periodic penalty payments" shall be replaced by the words "including periodic penalty payments."
15.
Reporting obligation for payers
(1) The employer is obliged to notify the competent health insurance undertaking of:
(a) recruitment and termination of the staff member; if the insured person is subject to § 3 (1) (b), he also announces this fact;
(b) the change of the health insurance undertaking by the employee, if that fact has been communicated to him; the notification shall be made by means of a write-off from the insurance premiums paid by the original health insurance undertaking and an insurance claim made by the health insurance undertaking chosen by the staff member;
(c) the facts relevant to the State's obligation to pay for the employees of the insurance premiums, even in cases where the State's obligation arose at the time when the staff member granted leave without compensation of the income, if he is aware of these facts.
The employer shall keep records and documentation of the facts notified.
(2) The staff member shall notify the relevant health insurance undertaking of the facts referred to in the previous paragraph without delay if he finds that his employer has failed to fulfil that obligation or if he has not communicated the information referred to in points (b) and (c) to his employer.
(3) An insurer who is a self-employed person is obliged to notify the competent health insurance undertaking of the commencement and cessation of self-employed activities no later than eight days after the date on which he has started or ceased that activity.
(4) The insured person shall notify the relevant health insurance undertaking within eight days of the date on which he became an insured person under Paragraph 6a (c).
(5) The insured person shall notify the relevant health insurance undertaking within eight days at the latest of the facts relevant to the formation or termination of the obligation of the State to pay the insurance premiums under § 6c. For persons employed, this obligation shall be fulfilled by the employer, if known. For persons who are minors or persons who are not fit for legal action, that obligation shall be fulfilled by their legal representative.
(6) The birth of the insured person shall be notified by his legal representative within eight days of the date of birth to the health insurance undertaking with which the mother of the child is insured on the day of birth. The competent municipal authority responsible for the management of the matrix shall notify the birth of the insured person to the Central Register of Insurers (23) immediately after the birth number has been assigned.
(7) The death of the insured person or his death declaration shall be notified to the Central Registry of the insured persons (23) within eight days of registration in the matrix by the competent municipal authority responsible for the management of the matrices.
23) § 27 of the ČNR Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by the ČNR Act No. 15 / 1993 Coll. '
16. Paragraph 10 (1) (a) reads as follows:
"(a) the choice of insurance undertakings carrying out general health insurance, unless otherwise provided for by this law. The health insurance undertaking may be changed once every 12 months only on the first day of the calendar quarter. The application must be lodged by the insured person with the selected insurance undertaking at least two months before the date specified in the previous sentence. A request shall be made by their legal representative for minors or persons who are not legal persons. The provisions of the previous sentence shall not apply when the health insurance undertaking is terminated. The right to choose a health insurance undertaking shall also not apply when the child is born. 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 may be requested only after the birth number has been assigned; the period laid down in the third sentence shall apply to the submission of this request. The insurance undertaking shall comply with the claims of the insured person within the time limits laid down in this provision. The health insurance company shall not be entitled to determine the period for which the insured person will be insured; it is not entitled to terminate the insured person's relationship with the health insurance undertaking itself, '.
17. In Paragraph 10 (2), the following sentences shall be added at the end: "Soldiers in the basic and substitute service and pupils in military schools shall be insured by the Military Health Insurance Company until the last day of the calendar month in which they have completed the basic or substitute service or study at the military school. From the first day of the following calendar month, they are insured with a health insurance company whose insured persons were insured before their transfer to the Military Health Insurance Company. To this end, the Military Health Insurance Corporation is required to communicate once a month to the Central Insurance Corporation of the General Health Insurance Corporation 23) the names, surnames, permanent stays and birth numbers of insured persons who have started or completed a basic or replacement service or study at a military school. For the change of the health insurance undertaking by the insured person referred to in the preceding paragraph, the period of insurance with Military Health Insurance shall not be counted within 12 months. ';
18.
"(b) inform its employer on the day of taking up employment with which health insurance is insured. It has the same obligation if another health insurance company becomes insured during the period of employment; that obligation shall be fulfilled within eight days of the date of the change of the health insurance undertaking. The employer shall confirm in writing the receipt of the communication according to the previous sentences. The employer shall have the right to require the employee or former employee to pay the periodic penalty payment which he has paid in connection with the non-notification or delayed notification of the change of the health insurance undertaking by the insured person, '.
19. Article 11 (h) to (o) shall be added as follows:
"(h) to avoid any conduct aimed at knowingly damaging its own health;
(i) to be demonstrated in the provision of health care, with the exception of the provision of medicinal products and medical devices, by a valid insurance card or by a replacement document issued by the relevant health insurance undertaking;
(j) notify the relevant health insurance undertaking within eight days of the loss or damage of the insured person's card;
(k) return to the relevant health insurance undertaking within eight days the insured person's card for:
1. the cessation of general health insurance under Article 5 (2) (b) and (c);
2. a change in the health insurance undertaking;
3. long-term residence abroad (§ 7 (4)),
(l) to notify the competent health insurance undertaking of changes in the name, surname, permanent residence or birth number within 30 days of the date on which the change occurred;
(m) on the change of the health insurance undertaking, provide the newly elected health insurance undertaking with proof of the amount of the advances on premiums calculated from the assessment basis, if it is a self-employed person;
(n) when providing health care which the health insurance undertaking pays only partially in accordance with the Health Regulations (§ 2 (2)), to the healthcare establishment the difference between the price of the healthcare provided determined in accordance with the list of health performance and the price scale and the amount of remuneration by the health insurance undertaking concerned (§ 13 (3)). The remuneration shall be rounded down to the nearest ten crowns; payment is at least CZK 10. The medical establishment shall be required to issue an accounting document on the nature and extent of the healthcare provided and the amount of the financial compensation received,
(o) when dispensing medicinal products and medical devices which are only partially covered by the health insurance company, to pay the difference between the price of the medicinal product or the medical device determined in accordance with the price regulations and the amount of the reimbursement by the relevant health insurance undertaking, in accordance with the list of medicinal products and medical devices (§ 13 (5)). "
20. Paragraph 12 shall be added to paragraph 3:
"(3) Health insurance companies shall issue their insured persons with an insurance card or a replacement document free of charge. The certificate or replacement document of a minor insured person or persons deprived of legal capacity shall be issued by the competent health insurance undertaking to the legal representative. ';
21. In Paragraph 13 (1), the words "unless otherwise agreed," shall be replaced by "agreed."
22. Article 13 (3) reads as follows:
"(3) The relevant health insurance undertaking shall provide remuneration for the medical performance performed by the healthcare establishment in accordance with the list of performance with points, unless the Health Regulations provide that health care is to be paid by flat-rate amounts. The contract referred to in paragraph 1 may provide for a reduction in the payment of the declared health performance where the health care establishment substantially exceeds the average cost per insured person of the relevant health insurance undertaking for the type of health care establishment and the health care sector. The list of points and the amount of lump sums, including the extent of the health care covered by these amounts, shall be established by the Ministry by means of a decree following a conciliation procedure with representatives of the Ministry of Finance, Insurance companies, other health insurance companies, contractual health institutions, professional organisations established by law and professional scientific societies. Participants shall be convened by the Ministry at least once a year. The Ministry of Finance, after consulting the Ministry of Labour and Social Affairs, shall determine, on a proposal from health insurance companies, the maximum price of the point. '
23. in Paragraph 13 (4) (b), point 3 is deleted and the following point (c) is added:
"(c) the account submitted by the contractual medical institution or other contracting entities for any service intervention on the medical equipment provided.";
24. in Paragraph 13 (5), the words "with the Czech Chamber of Pharmacy, Insurance and Health Insurance" shall be replaced by the words "with representatives of the Ministry of Finance, Insurance, other health insurance companies, contractual health institutions, professional organisations established by law (1) and professional scientific societies."
25. Article 13 shall be added in paragraph 7:
"(7) The relevant health insurance company shall ensure the lending of medical equipment thus designated in the list of medicines and medical equipment and shall keep records thereof. The issue of medical devices or their lending shall be recorded by the prescribing physician in the medical documentation of the patient. ';
26. Paragraph 14 shall be added to paragraph 6:
"(6) Revision practitioners shall not carry out control activities in a health facility of which the staff, owners, joint owners, operators, members of the statutory body, or where there is reasonable doubt as to their relationship with the checked persons or the subject matter of the check. Revision doctors shall be required to notify the health insurance undertaking for which they are carrying out their supervisory activities immediately after they have become aware of the facts suggesting their bias. '
27. Article 16 (4) reads as follows:
"(4) In the event of a failure to comply with the obligation to undergo a preventive examination in accordance with § 11 (f), or in the event of a breach of the obligations under § 11 (j), (k), and (l), or if the insured person has been released prematurely from constitutional care for a continuous gross breach of the constitutional health system's domestic rules, the competent health insurance company may impose a fine on the insured person up to CZK 500. The health insurance company may also impose a fine of up to CZK 5000 to the insured person, who has been proven by his health care card even though he was no longer an insured person at the time. The fine may be imposed within one year of the date on which the competent health insurance undertaking has established an infringement or failure to comply with the obligation, but no later than three years from the date on which the infringement or non-compliance occurred. ';
28. Paragraph 17 (1), including footnote 24, reads as follows:
"(1) The relevant health insurance undertaking may measure a premium to an insurance employer who has experienced repeated accidents at work or occupational diseases from the same causes during the previous calendar year, 24) and, as a result, an increase in the cost of health care, with the exception of accidents at work or occupational diseases which are not detected or which have been at risk from animals or natural elements or as a result of the infringement of third parties.
24) Annex No. III (3) of the Order of the Czech Labour Safety Authority and the Czech Mining Authority No. 110 / 1975 Coll., on the registration and registration of accidents at work and reports of accidents (accidents) and technical equipment disorders, as amended by the Order of the Czech Labour Safety Authority and the Czech Mining Office No. 274 / 1990 Coll. '
Article 29 (17) (3) reads as follows:
"(3) The payment notice for the premium for the calendar year may be issued no later than 30 June of the calendar year following the year in which the information referred to in paragraph 1 occurred. The premium shall be paid on a one-off basis on behalf of the relevant health insurance undertaking. ';
30. in Paragraph 17 (4), the following is added after the word "records":
"25) Annex I to the Order of the Czech Labour Safety Authority and the Czech Mining Office No. 110 / 1975 Coll., as amended by the Order of the Czech Labour Safety Authority and the Czech Mining Office No. 274 / 1990 Coll."
31. Paragraph 17 shall be added to paragraph 6:
"(6) As regards the maturity of the premium, the method of its payment, its enforcement, limitation, and the refund of the premium premium shall be the same as for insurance premiums. '
32. Paragraph 18 (1) of the first sentence, including footnote 26, reads: "The general rules on administrative procedures apply to decisions taken by health insurance undertakings in matters relating to premiums and fines and, in the cases at issue, to the payment of premiums, periodic penalty payments, the refund of premiums and the reduction of premiums advances. 26)
26) Act No. 71 / 1967 Coll., on Administrative Procedure (Administrative Regulations). '
33. In the first sentence of Paragraph 18 (2), the words "two representatives' are replaced by the words" one representative '.
34. in Paragraph 18, the following paragraph 3 is inserted after paragraph 2:
"(3) The arbitration authority may remove hardness which would arise when imposing a fine or measuring periodic penalty payments or premium payments. No appeal shall be admissible against the decision to remove hardness. '.
Paragraphs 3 and 4 shall be renumbered paragraphs 4 and 5.
35. in Paragraph 19, the following is added after the words "insurance contract":
Sign in for notes, favorites and notifications
Regulation Information
| Citation | Act No. 59 / 1995 Coll., amending and supplementing the Act of the Czech National Council No. 550 / 1991 Coll., on General Health Insurance, as amended, Act of the Czech National Council No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended, Act of the Czech National Council No. 589 / 1992 Coll., on Insurance for Social Security and Contribution to State Employment Policy, as amended, and Act of the Czech National Council No. 337 / 1992 Coll., on Tax Administration and Fees, as amended |
|---|---|
| Regulation Type | Law |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 24.04.1995 |
|---|---|
| Effective from | 01.05.1995 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
Comments 0