Act No. 60 / 2014 Coll.
Act amending Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, and other related laws
Valid
Effective from 22.04.2014
60
THE LAW
of 19 March 2014
amending Act No 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended, and other related laws
Parliament has decided on this law of the Czech Republic:
Amendment to the Public Health Insurance Act
Act No. 1 / 2006, Act No. 1 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 1 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5 / 2006, Act No. 5, Act No. 5 / 2006, Act No. 2006, Act No. 2006, Act No. 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006, No 2006,
1. In Article 1 (1), the words "the European Communities' are replaced by the words" the European Union1), and the provisions of the directly applicable European Union51) '.
footnotes 1 and 51 are as follows:
"(1) Council Directive 89 / 105 / EEC of 21 December 1988 on the transparency of pricing measures for medicinal products for human use and their inclusion in the scope of national health insurance schemes. Directive 2011 / 24 / EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcare. Commission Implementing Directive 2012 / 52 / EU of 20 December 2012 laying down measures to facilitate the recognition of medical prescription issued in another Member State.
51) Regulation (EC) No 883 / 2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, as amended. Regulation (EC) No 987 / 2009 of the European Parliament and of the Council of 16 September 2009 laying down detailed rules for the application of Regulation (EC) No 883 / 2004 on the coordination of social security systems, as amended. Regulation (EU) No 1231 / 2010 of the European Parliament and of the Council of 24 November 2010 extending the scope of Regulations (EC) No 883 / 2004 and (EC) No 987 / 2009 to third-country nationals not yet covered by those Regulations solely on grounds of their nationality. ';
2. In Article 1 (2), the words "in the field of coordination of social security schemes' are replaced by the words" regulating the coordination of social security schemes ("the coordination regulation ')'.
3. In Article 11 (1) (b), the words "on the territory of the Czech Republic" shall be inserted after the word "Services."
4. In Article 11, at the end of paragraph 1, the dot is replaced by a comma and the following points (l) to (n) are added:
"(l) to compensate for the costs incurred in urgent medical care carried out abroad only up to the amount fixed for the payment of such care if it were granted on the territory of the Czech Republic,
(m) reimbursement of the costs incurred for health services in another Member State of the European Union in respect of health services which, when provided on the territory of the Czech Republic, would be covered by health insurance (hereinafter referred to as "paid cross-border services"), only up to the amount laid down for the reimbursement of such services if provided on the territory of the Czech Republic,
(n) information on the possibility of drawing on health services in other Member States of the European Union. ";
5.
(1) Health insurance covers health services provided in the Czech Republic.
(2) At the request of the insured person, sickness insurance shall be granted to cover the costs of urgent medical care incurred during his stay abroad, up to the amount specified for such services if they were provided in the Czech Republic.
(3) Health insurance shall, upon request, provide the insured person with compensation for the costs incurred for the cross-border services covered, up to the amount specified for the reimbursement of such services, if they were provided in the Czech Republic. If the reimbursement of the costs of the cross-border services covered is conditional on the granting of prior consent pursuant to Paragraph 14b, it shall be granted only if prior consent has been given.
(4) The first sentence of paragraph 3 shall apply to the reimbursement of costs incurred by the insured person and not covered by the coordination regulations if, when providing the cross-border services covered, the necessary care to be paid under the coordination regulations and the costs associated with its drawing are only partially borne. In such a case, the insured person shall be granted compensation for the costs incurred by him, equal to the amount calculated as the difference between the total amount of the health service which would be covered by health insurance when provided on the territory of the Czech Republic and the total amount that is paid for such health service under the coordination regulations. If the calculated amount is greater than the amount incurred by the insured person, it shall be reimbursed only for the amount incurred.
(5) If the conditions for reimbursement of the services paid are laid down by this Act or by a decision of the State Institute for Drug Control (hereinafter referred to as "the Institute '), those conditions must also be fulfilled for compensation for the cross-border services covered; the conclusion of a contract for the provision and reimbursement of services paid shall not be considered to be such a condition.';
6. After Paragraph 14, the following Sections 14a to 14c are inserted:
The amount of the reimbursement of costs pursuant to Article 14 (2) to (4) shall be determined on the basis of this Act, the decree issued pursuant to Article 17 (4), the price regulation, the general measure referred to in Article 15 (5) and the decision of the Institute in accordance with the sixth effective part on the date on which the accounting document on which the compensation is made is drawn up; This applies mutatis mutandis to the reimbursement of costs incurred by insured persons in connection with the drawing of health services in another Member State of the European Union, the European Economic Area or the Swiss Confederation for which authorisation has been granted under the coordination regulations ensuring the payment of such health services (hereinafter referred to as the "authorisation under the coordination regulations').
Prior approval
(1) The Government may, by regulation, define the services covered by the cross-border service for which the reimbursement of the costs referred to in Article 14 (3) is subject to prior consent. As covered cross-border services for which reimbursement of costs is subject to prior approval, only the definition of:
(a) scheduled services for which time limits are laid down by government regulations on the local and time availability of health services and which at the same time require hospitalisation or highly specialised instrumentation or medical equipment; or
(b) paid services which include treatment which presents a particular risk to the patient or the population.
(2) The Ministry of Health shall notify the European Commission for which the services covered are subject to prior approval.
(3) The competent health insurance undertaking shall decide on the granting of prior consent at the request of the insured person. The application shall be submitted at the latest before the start of the drawing-up of the cross-border services paid.
(4) A health insurance undertaking may refuse to give prior consent only if:
(a) the insured person would be exposed to a risk which cannot be considered acceptable, taking into account the potential benefits of the use of such paid cross-border services, due to his state of health when drawing paid cross-border services;
(b) there is a reasonable concern that the use of paid cross-border services could result in a significant threat to public health;
(c) there is a reasonable concern as to who is to provide the covered cross-border services with regard to compliance with the standards and guidelines on the quality of the health services provided by it and the safety of the insured person; or
d) the required health services may be provided to the insured person within the territory of the Czech Republic within the time-limit set by the Government Decree on the local and temporal availability of health services.
(5) At the same time, the health insurance undertaking must assess the conditions for granting an authorisation under the coordination regulations when examining the insured person's application for prior consent. If these conditions are met, the health insurance undertaking shall authorise the insured person in accordance with the coordination regulations; This is not the case if the insured person stated in the application that he is only asking for prior consent and that he is still requesting it after being informed by the health insurance undertaking of the benefits of granting authorisation under the coordination regulations compared to giving prior consent.
(1) Information relating to the use of health services in the Member States of the European Union is provided by a national contact point designated as a liaison point for health insurance under the coordination regulations (hereinafter referred to as the contact point). The Ministry of Health communicates the name and contact details of the contact point to the European Commission and publishes them on the official record and in the Ministry of Health Bulletin. The name and contact details of the contact point shall be published on their website by health insurance companies.
(2) The contact point provides in particular information on:
(a) the possibilities of drawing on health services in the Member States of the European Union;
(b) providers,
(c) contact details of national contact points in other Member States of the European Union;
(d) the legislation of the Czech Republic governing standards and guidelines on the quality and safety of the provision of health services, including provisions on the supervision and evaluation of providers, and the providers to which those standards and guidelines apply;
(e) patients' rights, complaint procedures and redress mechanisms and dispute resolution in the Czech Republic;
(f) the particulars to be given under the legislation of the Czech Republic on the medical rules which are issued at the request of a patient who intends to apply them in another Member State of the European Union.
(3) The contact point also provides information on
(a) the authorisation of a particular provider to provide health services or any restrictions on its authorisation;
(b) accessibility of specific health facilities in the Czech Republic for people with disabilities;
(c) the possibility of drawing on health services under the coordination regulations;
(d) the rights of the insured person in connection with the drawing of health services in other Member States of the European Union, in particular on the rules and conditions governing reimbursement of costs and procedures for their application;
(e) the rights of a patient from another Member State of the European Union on the territory of the Czech Republic in relation to the drawing of health services, in particular on the possibilities of appeal and correction, if the patient considers that he has been harmed on his rights, including in cases where harm is caused as a result of the use of health services.
(4) When providing information relating to the use of health services in another Member State of the European Union, the contact point shall communicate the rights deriving from the coordination regulations and resulting from this law. The contact point shall publish the information referred to in paragraph 2 on its website. The information referred to in paragraphs 2 and 3 shall be made available, upon request, in a form which allows persons with disabilities to become familiar with such information to the extent necessary.
(5) The contact point shall cooperate to exchange the necessary information and examples of good practice with national contact points of other Member States of the European Union, the European Commission, health insurance companies and patient associations active in the protection of the rights of such persons.
(6) Providers, competent authorities for the provision of health services and health insurance undertakings are required, upon request, to provide the contact point with the information referred to in paragraphs 2 and 3 without delay and free of charge where such information is available to them. '
7. In Paragraph 15 (5), the words "the State Institute for Drug Control (hereinafter referred to as the Institute ')' are replaced by the words" the Institute '.
8. In Paragraph 16a (2), in the introductory part of the provision, the words "(a) to (f) 'are replaced by the words" (a) to (e)'.
9. Paragraph 16a (4) is deleted.
Paragraphs 5 to 11 shall be renumbered paragraphs 4 to 10.
10. in Article 16a (5), the second sentence shall be deleted;
11. in Article 16a (8), "2 to 4" is replaced by "2 and 3."
12. in Article 16a (10), "9 and 10" is replaced by "8 and 9."
13. in Article 16b (2), first and second sentences, "7 and 8" shall be replaced by "6 and 7."
14. In Paragraph 40, the following paragraphs 3 and 4 are inserted after paragraph 2, including footnote 52:
"(3) Health insurance companies shall decide on their insured persons' applications for authorisation under the coordination regulations. The application shall show which health services the insured person intends to draw, the place of their drawing and the estimated duration of their drawing. The health insurance undertaking shall grant authorisation under the coordination regulations only if the conditions laid down in the coordination regulations are met for its issue. If there is a reasonable concern that the required health service cannot be provided to the insured person on time and if there is a risk of delay due to his medical condition and the probable course of illness, the health insurance undertaking must issue an authorisation under the coordination regulations without delay.
(4) At the request of the insured person, health insurance undertakings shall pay the costs referred to in paragraphs 2 to 5 of Article 14 not later than the last day of the month following the date on which the decision under Paragraph 53 (1) becomes final.
52) Article 20 of Regulation (EC) No 883 / 2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, as amended. '
Paragraphs 3 to 10 shall be renumbered paragraphs 5 to 12.
15. in Paragraph 40 (12), "7 and 8" is replaced by "10 and 11."
16. In Paragraph 40, paragraphs 13 and 14 are added:
"(13) Health insurance companies shall collect data relating to administrative procedures relating to the reimbursement of the costs of health services provided by insured persons in other Member States of the European Union, in particular information on:
(a) proceedings for reimbursement of costs initiated pursuant to Article 14 (2) to (4), their number, their place of drawing and, as decided in each proceeding,
(b) proceedings initiated for the granting of prior consent, their number and the decision taken in each proceeding;
(c) the amounts which have been reimbursed to insured persons under § 14 (2) to (4).
(14) The data collected pursuant to paragraph 13 shall be communicated by health insurance undertakings in an anonymous form at the request of the Ministry of Health. The Ministry of Health shall provide this information to the European Commission within the time limits set by it. ';
17. in the first sentence of Paragraph 53 (1), the words "the granting of prior consent under § 14b, the granting of authorisation under the coordination regulations, the reimbursement of costs under § 14 (2) to (4)," and the sentences of the third and the fourth sentences are replaced by the words "Health insurance undertakings shall decide on premiums, fines and likely premiums and, in the cases at issue, on premiums and periodic penalty payments. The appeal against the payment notice shall not have suspensory effect. '.
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. 117 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 296 / 2007 Coll., Act No. 455 / 2003 Coll., Act No. 438 / 2004 Coll., Act No. 117 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 296 / 2007 Coll., Act No. 362 / 2009 Coll.
1. the following shall be added to Article 5 (c), including footnote 1a:
"(c) reimbursement of the costs of urgent medical care taken abroad by the insured person and reimbursement of the costs of medical services taken by the insured person in another Member State of the European Union under Section 14 of the Public Health Insurance Act (1a);
(1a) Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended. '
2. In Article 5, at the end of point (e), the dot is replaced by a comma and the following point (f) is added:
"(f) the remuneration for health services and the reimbursement of the costs incurred by the insured person in the Member States of the European Union, the European Economic Area or the Swiss Confederation under the provisions directly applicable to the coordination of social security systems and under international social security agreements.";
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. 261 / 2007 Coll., Act No. 296 / 2007 Coll., Act No. 351 / 2009 Coll., Act No. 117 / 2006 Coll., Act No. 267 / 2006 Coll., Act No. 261 / 2007 Coll., Act No. 296 / 2007 Coll.
1. in Paragraph 13 (c), including footnote 23:
"(c) reimbursement of the costs of urgent medical care taken abroad by the insured person and reimbursement of the costs of medical services taken by the insured person in another Member State of the European Union under Section 14 of the Public Health Insurance Act (23);
23) Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended. '
2. In Article 13, at the end of point (e), the dot is replaced by a comma and the following point (f) is added:
"(f) the remuneration for health services and the reimbursement of the costs incurred by the insured person in the Member States of the European Union, the European Economic Area or the Swiss Confederation under the provisions directly applicable to the coordination of social security systems and under international social security agreements.";
Amendment to the Health Services Act
In Article 45 of Act No. 372 / 2011 Coll., on health services and the conditions for their provision (Health Services Act), as amended by Act No. 303 / 2013 Coll., at the end of paragraph 2, the dot is replaced by a comma and the following point (o) is added, including footnote 50:
"o) provide information to the national contact point at its request under the Public Health Insurance Act 50).
50) § 14c of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended. '
EFFECTIVE
This Act shall take effect on the 15th day following its publication.
Hamlet v. r.
Zeman v. r.
Sobotka v. r.
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Regulation Information
| Citation | Act No. 60 / 2014 Coll., amending Act No. 48 / 1997 Coll., on Public Health Insurance, and amending and supplementing certain related laws, as amended, and other related laws |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 07.04.2014 |
|---|---|
| Effective from | 22.04.2014 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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