Decree No. 644 / 2004 Coll.
Ordinance on management rules with a special general health insurance account, average costs and rules of procedure of the supervisory authority
Valid
Effective from 01.01.2005
644
DECLARATION
of 13 December 2004
on the management rules for the special general health insurance account, the average costs and the rules of procedure of the supervisory authority
In agreement with the Ministry of Finance, the Ministry of Health provides, pursuant to Article 20 (6) of Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by Act No. 438 / 2004 Coll., ("the Act '):
Subject matter
This decree regulates the management rules with a special general health insurance account, details of the application of the claim for care, the method of calculating the average costs of insured persons in each group by age and sex, the cost indices of age groups, including the valuation and allocation of costs to those groups, and the average costs per insured person in the general health insurance scheme and the rules of procedure of the supervisory authority.
Preliminary provisions
The General Health Insurance Company of the Czech Republic (1) (hereinafter referred to as "Insurance Company ') and the Department, Business, and Other Health Insurance Corporation (hereinafter referred to as" Employee Insurance Company') communicate to the Insurance Company, which under the law manages a special account (hereinafter referred to as "Account Manager ') the information required for the distribution of insurance premiums to general health insurance. Such data shall be communicated in a written or electronic form, with a guaranteed electronic signature based on a qualified certificate (3) in the data interface established by the account administrator.
Average cost per insured person in the general health insurance scheme
(1) Insurance and occupational insurance companies shall provide account administrators, within the time limit set for the submission of annual reports, with data from their annual reports on the total cost of health care covered by public health insurance to the extent and under the conditions laid down by the special legislature4 (hereinafter referred to as "paid care"), charged and recognised in the calendar year concerned and provided in the Czech Republic and the number of their insured persons on 31 December of the relevant calendar year.
(2) The administrator of the account shall calculate the average cost per insured person in the general health insurance scheme by insurance and occupational insurance undertakings referred to in paragraph 1 and communicate them within 35 days of the provision of such information to the Insurance and Occupational Insurance undertaking and to the Occupational Insurance undertaking.
Cost indices of age groups and valuation and allocation of costs
(1) Insurance and occupational insurance companies shall provide the administrator of the account for the previous calendar year and within the deadline set for the submission of their annual reports through the Ministry of Health to the Ministry of Finance, the number of insured persons and the total annual cost of insured persons per group by age and sex. From these costs they deduct part of the costs of the costly insured persons under Section 21a (3) of the Act and Article VI of 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, 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 (Act No. 438 / 2004 Coll.).
(2) For determining the number of insured persons per group by age and sex and the total annual cost of insured persons per group by age and sex Insurance and occupational insurance
(a) use:
1. the number of insured persons per group by age and sex on the first day of the month concerned;
2. the average number of insured persons per group by age and sex for the last officially closed calendar year calculated as a proportion of the sum of the number of insured persons per group by age and sex on the first day of all months of the calendar year and of heading 12;
b) assign health care to the insured person by:
1. the total annual costs of the insured person shall include all the costs of health care provided to the insured person, the remuneration of which is set in the crowns, and the amount of the amounts of points declared by the health care institutions which have been declared with the accounts for the calendar year and the insurance or occupational insurance undertakings recognised,
2. the effects of legal and contractual regulatory and regulatory mechanisms or any increase in the total remuneration due to the annual increase in the collection of premiums are not included in the total annual health care costs;
(c) use for valuation
1. the paid care declared and recognised at points the price of the point which was published in the Ministry of Health Bulletin as a result of an agreement under the special legislature5 (hereinafter referred to as "conciliation procedure") for a given group of health institutions and for a given period, or determined under the special legislature6). Where, for a group of medical establishments and periods, the price of the point referred to in the first sentence has not been published, the last published price of the point for that group of medical establishments shall be used for the valuation. Where a point price has been published or fixed as a minimum for a group of medical devices, this price shall be used for the valuation. Where a different point price has been published or determined for a part of a group of medical establishments, the price of the point shall be used for that part of the medical establishment,
2. payments for the number of registered insured persons to the practitioners valid for the minimum amount of such payment for the period agreed in the conciliation procedure;
(d) allocate the costs referred to in point (b), measured in accordance with point (c), to each group by age and sex, depending on the age of the insured person achieved on the first day of the calendar month in which the care paid was provided.
(3) In order to determine the costly insured persons and to deduct the costs paid by Insurance and Occupational Insurance companies pursuant to Article 21a (3) of the Act and Article VI (1) of Act No. 438 / 2004 Coll. the total amount of the costs assigned and valued in accordance with paragraph 2, which have been declared by health care institutions with accounting for the calendar year and recognised by insurance or occupational insurance companies, is decisive. In the case of a costly insured person (7) during the calendar year belong to two groups by age and sex, Insurance and Occupational Insurance companies shall include the relevant part of the cost of the insured person under Section 21a (3) of the Act and Article VI (1) of Act No 438 / 2004 Coll. deducted from the costs of the group by age and sex, to which the insured person belongs in the month concerned.
(4) The administrator of the account shall calculate, within 35 days of the provision of the data by insurance and occupational insurance undertakings referred to in paragraph 1, the cost indices of each group by age and sex and shall communicate them to the Ministry of Health.
Application of the right to reimbursement of costly insured persons
Insurance and occupational insurance companies shall account for all their costly insurers for the relevant calendar year in accordance with Section 21a (3) and (10) of the Act. The bill also includes insurance and occupational insurance companies claimed amount of expensive care. Annex No 1 sets out the data interface for the transmission of the bill to the Insurance and Occupational Insurance payers.
Management rules for a special account
(1) On the basis of a written communication from the Insurance and Occupational Insurance Authority on the incorrectly reported number of insured persons for which the insurance State is the payee, the administrator of the account shall, at the earliest notification to the Ministry of Finance pursuant to Article 27 (3) of the Act, correct these data for the entire period for which they were wrongly notified.
(2) Where the written notification referred to in paragraph 1 shows that:
(a) the number of insured persons notified was less than the actual number of insured persons determined, the State shall pay the premium on the basis of the assessment provided for by the special legislation provided for in Article 3c of the Act for the number of insured persons which makes up the difference between the number notified and the actual number found. This supplement shall be made at the same time as the nearest monthly payment for the person for whom the insurance company is the payer. The supplement shall be reallocated at the same time as the monthly payment with which it was paid. In this redistribution, the insurance and occupational insurance undertakings are also added the difference between the incorrectly notified and corrected number of insured persons for which the insurance company is the payee for the whole period for which the information was wrongly reported,
(b) the notified number of insured persons was greater than the actual number found, the administrator of the account shall notify the Ministry of Finance of the excess premium. The excess premium shall be settled with the insured State at the earliest monthly payment under Section 12 of the Act. In this redistribution, insurance and occupational insurance undertakings shall also be deducted from the difference between the incorrectly reported and corrected number of insured persons for which the insurance company is the payee for the whole period for which the information was incorrectly reported.
(3) On the basis of a written communication by the Insurance and Occupational Insurance Corporation on the incorrectly reported number of insured persons per group by age and sex, the administrator of the account shall, at the earliest distribution before calculating the total amount of the correction by adding or subtracting the difference between the incorrectly reported and the actual number of insured persons by age group.
(4) If the Insurance and Occupational Insurance Corporation miscommunicate the amount of the premiums collected incorrectly, the administrator of the account shall, at the earliest reallocation before calculating the total amount, make a correction by adding or subtracting the difference between the amount of premiums collected wrongly disclosed and the amount of premiums actually determined.
(5) Before determining the proportion of the standardised insured person under Section 21 (3) of the Act, the administrator of the account shall deduct from the monthly insurance premiums paid by the State funds equal to the total amount of the funds for the monthly advance payments.
(6) Before determining the proportion of the standardised insured person in the month in which he accounts for the annual advance payments for the cost of care, the administrator of the account shall settle with the monthly insurance premium paid by the State the funds equal to the difference between the claims of the Insurance and Occupational Insurance undertakings and the amount of the advance payments for the costly insured persons.
(7) The funds belonging to the Insurance and Occupational Insurance Corporation under Section 21a (9) of the Act will be transferred by the administrator of the account in two parts. The first part of the payment shall be provided from the funds of the insurance premiums paid by the State, immediately after notification of the results of the reallocation pursuant to Section 21a (7) of the Act. The second part of the payment shall be made by the Insurance and Occupational Insurance Corporation on receipt of payments from the Insurance and Occupational Insurance Corporation pursuant to Section 21a (8) of the Act, but no later than 10 working days after the first part of the payment under Section 21a (9) of the Act.
(8) The administrator of the account has rounded up the calculated total amount attributable to the Insurance and Occupational Insurance Corporation after the transfer to the whole crown down. This shall also apply mutatis mutandis to the calculated total amount of the monthly advance payment and the total amount of the cost of care to which the Insurance and Occupational Insurance Corporation is entitled for the last accounting year closed and the average cost per insured person in the general health insurance scheme.
(9) The account administrator rounded the cost indices to the nearest 4 decimal places.
Rules of Procedure of the Supervisory Body
(1) The members of the Supervisory Body appointed or authorised by membership of the Supervisory Body pursuant to Article 20 (5) of the Act shall transmit a certified copy of their appointment or mandate to the Supervisory Authority to the administrator of the Account.
(2) The members of the supervisory authority shall elect a Chairperson, Vice-President and Managing Director from among themselves for a period of one year. In this election, each member of the supervisory authority shall have one vote, stating that the representatives of the occupational insurance undertakings shall have one vote together). The President, Vice-President and Director may also be re-elected. The Vice-President of the Supervisory Body shall represent the President in his absence in his full capacity. The manager of the supervisory authority shall carry out the tasks assigned to it by the supervisory authority in connection with the provision of organisational arrangements for the activities of the supervisory authority.
(3) The meetings of the supervisory authority shall be convened once a month by the chairman of the supervisory authority. If necessary, an emergency meeting shall be convened by the President, the Vice-President or the administrator of the account. At a time when neither the Chairperson nor the Vice-Chair of the Supervisory Body is elected, he shall convene meetings of the Supervisory Body of the administrator of the Account.
(4) The hearing of the supervisory authority shall be private. On a proposal from a member of the supervisory authority, the Chairman of the supervisory authority may invite other persons to the meeting to discuss issues relating to the supervision of compliance with the management rules with the special account.
(5) The representative of the account administrator shall inform the supervisory authority at each meeting of the management of the special account, transmit to all members the data transmitted by the Insurance and Occupational Insurance Corporation under this Order, the results of the monthly redistribution carried out, the annual accounts of the insured persons and the amounts claimed for them once a year.
(6) The supervisory authority shall, at its meeting, instruct its members in writing to check the information provided by the Insurance and Occupational Insurance Corporation, which shall be the monthly basis for the reallocation of insurance premiums.
(7) A record of the conduct of the proceedings shall be drawn up by the agent, who shall send the administrator of the account to all members of the supervisory authority. Any objections to the content of the minutes shall be discussed at the next meeting of the supervisory authority. The minutes shall always include the date of the hearing, the list of members present and the brief content of the hearing on each item under consideration with the conclusions reached.
(8) Prior to the beginning of the meeting, participants may agree to obtain an audio record by the account administrator's representative. The issuing of an alert shall be put to the vote in the manner referred to in paragraph 9, with no audible recording being issued in the event of a tie. The record shall be transmitted to the administrator of the account until the supervisory authority decides on its comitological liquidation.
(9) A decision may be taken by the supervisory authority only where the members of the supervisory authority present have at least 3 votes. The decision shall be taken in public. The supervisory authority shall take its decisions by a majority vote. The Chair of the Supervisory Body shall convene a new meeting of the Supervisory Body by the end of the following week at the latest. The vote of employee insurance undertakings for or against the decisions of the supervisory authority shall be recorded separately from the result of the voting members present, of the representatives of those employees; in the event of a tie, the vote shall be repeated and the vote shall be deemed to be abstention.
Common provision
(1) An amount of CZK 354 900 shall be used to determine the advance payments of the care and the insured person for 2003, which is thirty times the average cost per insured person in the general health insurance scheme in 2001.
(2) The amount of CZK 396 090, which is thirty times the average cost per insured person in the general health insurance system in 2002, will be used to determine the advances of the care and the insured person in 2004.
(3) An amount of CZK 420 900 will be used to determine the advances of the care and the insured person in 2005, that is thirty times the average cost per insured person in the general health insurance system in 2003.
(4) The cost indices for redistribution in 2005 are set out in Annex 2.
(5) In 2005, the administrator of the account shall determine the total amount of funds for the monthly advance payments to Insurance and Occupational Insurance companies and the amount of advance payments to Insurance and Occupational Insurance undertakings pursuant to § 21a (5) and (6) of the Act on the basis of data provided by Insurance and Occupational Insurance Companies for 2003.
(6) In 2006, the account administrator shall determine the total amount of funds for the monthly advance payments to the Insurance and Occupational Insurance Corporation equal to the amount of advance payments to Insurance and Occupational Insurance undertakings under Section 21a (10) of the Act, the Insurance and Occupational Insurance Corporation shall provide these data in the data interface set out in Annex 1.
(7) In 2005, in which part of the premium is redistributed in accordance with Article VI (2), (3) and (5) of Act No. 438 / 2004 Coll., the administrator of the account shall include in the total amount that belongs to the Insurance and Occupational Insurance Corporation after the reallocation and which is compared with the collection of the premium under Article 21a (8) and (9) of the Act, 40% of the 65% of the premium collected remaining to the Insurance and Occupational Insurance Company under Article VI (3) of Act No. 438 / 2004 Coll.
(8) In 2006, in which part of the premium is redistributed in accordance with Article VI (2), (4) and (5) of Act No. 438 / 2004 Coll., the administrator of the account shall include in the total amount that is due to the Insurance and Occupational Insurance Corporation after the reallocation and which is compared with the collection of the premium under Article 21a (8) and (9) of the Act, 40% of the collected premiums remaining to the Insurance and Occupational Insurance Company under Article VI (4) of Act No. 438 / 2004 Coll.
Repeal
Decree No. 305 / 1996 Coll., on the Management Rules of the General Health Insurance Special Account and the Rules of Procedure of the Supervisory Body are hereby repealed.
Efficacy
This Decree shall take effect on 1 January 2005.
Minister:
Doc. MUDr. Emmer, CSc.
Příloha č. 1
Annex No 1 to Decree No 644 / 2004 Coll.
Data interface to account for costly insured persons
Příloha č. 2
Annex No 2 to Decree No 644 / 2004 Coll.
Cost indices for redistribution in 2005
| Věková skupina | Nákladové indexy 18 věkových skupin pojištěnců členěné podle pohlaví | ||
|---|---|---|---|
| od | do | Muži | Ženy |
| 0 | 5 | 1,5247 | 1,3161 |
| 5 | 10 | 0,9301 | 0,8124 |
| 10 | 15 | 0,8556 | 0,8390 |
| 15 | 20 | 0,7937 | 1,0000 |
| 20 | 25 | 0,7121 | 1,0844 |
| 25 | 30 | 0,7555 | 1,3844 |
| 30 | 35 | 0,8439 | 1,4002 |
| 35 | 40 | 0,9632 | 1,3554 |
| 40 | 45 | 1,1712 | 1,4990 |
| 45 | 50 | 1,5319 | 1,8846 |
| 50 | 55 | 2,1162 | 2,3109 |
| 55 | 60 | 2,8569 | 2,6241 |
| 60 | 65 | 3,4519 | 3,0564 |
| 65 | 70 | 4,2894 | 3,6547 |
| 70 | 75 | 5,1215 | 4,3501 |
| 75 | 80 | 5,6613 | 4,8750 |
| 80 | 85 | 5,8683 | 5,3291 |
| 85 | a více | 4,4390 | 5,4401 |
1) Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended.
2) Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended.
3) Act No. 227 / 2000 Coll., on Electronic Signature, as amended.
4) Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended.
5) Article 17 (5) of Act No. 48 / 1997 Coll., as amended.
6) Article II of Act No. 459 / 2000 Coll., amending Act No. 48 / 1997 Coll., on Public Health Insurance and amending and supplementing certain related laws, as amended. Government Decree No. 487 / 2000 Coll., establishing the value of the point and the amount of the health care payments paid from public health insurance for the first half of 2001. Decree No. 532 / 2002 Coll., determining the amount of public health care payments, including regulatory restrictions, for the first half of 2003.
7) § 21a (2) of Act No. 592 / 1992 Coll., as amended by Act No. 438 / 2004 Coll.
8) Paragraph 20 (5) of Act No. 592 / 1992 Coll., as amended.
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Regulation Information
| Citation | Decree No. 644 / 2004 Coll., on the Management Rules of the General Health Insurance Special Account, Average Costs and Rules of Procedure of the Supervisory Body |
|---|---|
| Regulation Type | - |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 22.12.2004 |
|---|---|
| Effective from | 01.01.2005 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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