Your Health Insurance

Health insurance is one of the legal obligations no expat living in the Czech Republic for longer than three months should ignore.

General information, as well as an explanation of both public and private systems, can be found in our infosheet on health insuranceThanks to several client cases we have dealt with recently, we realized there are seemingly minor details that should be pointed out as they might help you understand the system better and thus, hopefully, prevent possible complications in the future.

Private Health Insurance

Expats with private health insurance should pay extra attention in the following three situations:

1.  Prolongation of a contract

When prolonging one’s health insurance contract, it is important to bear in mind more serious diseases as well as medical treatments that might continue even once the original contract finishes. Unfortunately, all of these are usually taken into consideration as pre-existing medical conditions and might be a reason for not prolonging the commercial health insurance contract.

Shopping around and changing the health insurance provider in case there is a better deal surely makes sense. However, in case of a more dramatic change of medical condition, continuing with the same health insurance company usually gives you a better chance on passing smoothly from one contract to the next. Even then, it is highly recommended to discuss your options well in advance and double-check whether the ongoing treatment(s) will be covered by the new contract.

2. Pregnancy

Also, pregnancy requires more attention when it comes to health insurance. Generally, there is a three-month pre-existing period for pregnancy in comprehensive health insurance. It means that if a woman gets pregnant after this period of time, the healthcare during her pregnancy (including the delivery) is fully covered. The exact conditions vary according to the terms of the prepaid health insurance package.

However, the mother’s health insurance does not cover postnatal care in the hospital. For this reason, as well as in case a woman gets pregnant during the first three months of her health insurance period or if she is already pregnant when signing the contract, an extra health insurance package is needed. This insurance covers both pregnancy and postnatal care in the maternity hospital (for a defined period of time and within the set financial limits). As there is always a risk of complications or birth before term, this type of health insurance is required by all maternity hospitals before accepting a new patient and it is strongly recommended to get it as soon as a woman finds out she is pregnant.

Please, note that the medical condition of the mother-to-be is thoroughly checked by all private insurance providers before accepting her as their client and serious problems (e.g. risky pregnancy)  might be a reason for their refusal.

3. Refund

Last but not least, getting the costs of medical treatment refunded can cause a bit of confusion as the patient usually ends up with a refund smaller than the amount of money actually paid. The process of refunding medical costs in the Czech Republic is quite straightforward. It is based on a ‘point’ system where each medical intervention has a certain point value. The value of one point is usually 1 CZK, but some private health insurance providers can pay even a bit more per each point.

Although the cost of the actual medical treatment provided in the Czech Republic is the same for the clients of both private and public health insurance companies, the services provided by doctors tend to be more costly in case of foreign patients due to heavier administrative procedures and the language barrier. The coverage of this extra cost is up to the patient, unfortunately.

Public Health Insurance

In the case of public health insurance, it is mainly the question of eligibility that can be sometimes unclear, even confusing. Whereas all EU citizens living in the Czech Republic for more than three months automatically belong to the public health insurance system, the situation of their nonEU family relatives (spouses and children) can get a bit tricky.

If the EU citizen is not economically active, their nonEU family relatives still have a possibility to enter the public health insurance system once they have spent more than three months in the Czech Republic. If, however, commercial health insurance seems like a better option for them at the time, they can remain in the private system.

The situation changes once the EU citizen becomes economically active (whether employed or self-employed). From this moment onwards, their nonEU family relatives have a legal obligation to enter the public health insurance system.

It is up to the EU citizen (the individual, not their employer!) to register their spouse and/or children at their public health insurance office. If they fail to do so right away, a fine is imposed plus every month of every nonEU family member’s health insurance has to be paid back even in case they are covered by the private health insurance the whole time.

This article was written by BEC’s senior consultant, Lucia Konôpková, and Tomáš Ryšánek, an insurance specialist from BEC’s referral programme member, Pafin.

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