Every insured person of the VZP CR has the right to receive healthcare covered by public health insurance in the Czech Republic.
Article 31 of the Charter of Fundamental Rights and Freedoms, which states: "Everyone has the right to the protection of health. Citizens have the right to free healthcare and medical aids under public insurance under the conditions laid down by law" is often understood by the insured person to mean that all healthcare provided to them should be free of charge.
Currently, Act No. 48/1997 Coll., on Public Health Insurance, is in force, according to which every insured person has the right to choose both the health insurance company and the health service provider and healthcare facility that are in a contractual relationship with his or her health insurance company. In such a case, the person has the right to healthcare without direct payment (except for care listed in the Act as not covered by health insurance, covered under certain conditions or partially covered). If a contracted healthcare facility requires cash payment for covered care, it is acting in violation of the law.
For all types of care, including non-acute care, the insured person can also choose a non-contractual healthcare facility. However, he/she waives the right to have his/her care reimbursed by public health insurance and pays for all healthcare provided in a non-contractual healthcare facility, including medications and accompanying examinations, except for necessary and urgent care, out of his/her own funds.
Health services covered by health insurance
Health insurance pays for health services provided to improve or maintain the insured person's health or to relieve suffering. This includes:
- outpatient and inpatient medical care, including diagnostic care, rehabilitation and care for the chronically ill (medicines and medical devices indicated for inpatient treatment are fully covered by health insurance)
- emergency and rescue services
- preventive care
- dispensary care (continuous care for certain groups of patients or insured persons at risk)
- provision of medicinal products (medicinal products are reimbursed in accordance with Act No. 48/1997 Coll., on Public Health Insurance, as amended; the specific reimbursement is then determined by a decision of the State Institute for Drug Control, which also sets the maximum prices of medicinal products; for medicinal products reimbursed when providing inpatient care, the premise of reimbursement of the least economically demanding medicinal product applies, so that the insured does not participate in this reimbursement)
- provision of medical devices (medical devices are covered depending on the extent and severity of the disability in the basic version that is the least economically demanding in accordance with Act No. 48/1997 Coll., on Public Health Insurance, as amended; specific reimbursements are defined by the VZP - ZP Numbering List, as well as the possible condition of approval by the insurance company's reviewing physician)
- provision of dental products (determined by the valid price list of dental products)
- spa care and care in specialised children's hospitals and sanatoriums
- transport of patients and reimbursement of travel expenses
- assessment activities
- examination of the deceased insured person and autopsy including transportation.
Reimbursement of necessary and urgent medical care
If you need urgent medical treatment, you must not be refused by a healthcare facility – even a non-contracted one – and you must be treated without any payment being required.
By law, only necessary and urgent care is covered by health insurance companies for non-contracted healthcare facilities, which means the provision of healthcare
- in the event of an accident,
- at the onset of acute illness,
- in the event of acute deterioration of health,
- in an emergency delivery,
where a delay in medical care could lead to a life-threatening or serious deterioration in health.
Every insured person should be informed about the possibility of providing further care covered by health insurance in a contracted facility (if his/her health condition permits transfer to this facility) after the provision of necessary and urgent care in a non-contracted facility, with the understanding that he/she will have to pay for the further care in a non-contracted facility. Therefore, treatments in non-contracted facilities should only be chosen in very exceptional cases, when there is a risk of delay and the non-contracted facility is the most accessible.
We recommend our insured persons to give preference to the contracted medical facilities of VZP CR, which are sufficient in number in all the regions of the Czech Republic. Lists of healthcare facilities with which VZP CR has concluded agreements on the provision and reimbursement of healthcare are available at all VZP CR client offices.