Zdravotní pojišťovna ministerstva vnitra ČR (also known as “ZP 211”) with more than 1.3 million clients, is the second largest public health insurance fund in the Czech Republic.
ZP 211 provides public health insurance to cover healthcare costs from providers, specifically physicians and hospitals, in accordance with the Public Health Insurance Act (Act No. 48/1997).
Public health insurance is mandatory for all persons who have their permanent residence in the Czech Republic or who work for an employer with a registered office or permanent residence in the Czech Republic.
Certain foreign nationals who are, in accordance with the related Czech legislation, considered to have permanent residence in the Czech Republic are also covered by the public health insurance scheme, including foreign nationals with a long-term residence permit for the purpose of scientific research, foreigners who are international protection applicants, foreign nationals being tolerated in the Czech territory, foreign nationals granted temporary protection, and asylum seekers.
A new rule applies from 2 August 2021 to new-born children whose mother has the long-term residence permit in the Czech Republic. These children born in the Czech Republic are also covered within the public health insurance scheme however the insurance period is only until the last day of the calendar month in which the child reaches the age of 60 days.
Participation in the public health insurance scheme becomes mandatory from the beginning of permanent residence or upon starting employment in the Czech Republic.
Every person participating in the public health insurance scheme is required to pay health insurance contributions.
Because of the country’s EU membership and also certain international social security treaties, participation in the Czech public health insurance scheme also becomes mandatory for EU nationals (and certain foreign nationals) who have gainful economic activity in the Czech Republic, regardless of whether they are employees or self-employed. In accordance with EU Regulation No. 883/2004 On the Coordination of Social Security Systems, Czech public health insurance scheme might also apply to pensioners receiving a pension in the Czech Republic, family members of persons undertaking gainful economic activity and being insured in the Czech Republic, and also non-active persons who have their place of residence or a centre of interest in the Czech Republic.
For certain groups of persons, health insurance contributions are paid by the State. These State-insured participants are not required to pay health insurance contributions. This mainly includes dependent children and students up to the age of 26 years, women on maternity or parental leave, persons receiving a parental allowance, senior citizens (recipients of benefits under the Czech old-age pension scheme) etc. (For additional information, see the question: “For which persons does the State pay health insurance contributions?”)
Each participant has the right to choose a public health insurance fund, with the exception of new-born children, who are registered with the same public health insurance fund as their mother. In addition, every person has a right to transfer to another public health insurance fund once in every 12 months.
It is compulsory for each participant to prove their insurance by a valid health insurance card or a provisional replacement certificate when receiving medical treatment. In the case of a lost or stolen health insurance card, it is necessary to contact ZP 211 as soon as possible and apply for a replacement card.
All participants of a public health insurance scheme are obliged to inform their public health insurance fund of any change of facts relevant for paying health insurance contributions and for their participation in the public health insurance scheme. For additional information, contact the ZP 211 Information Centre at email@example.com.
ZP 211 AND HEALTH INSURANCE IN BRIEF
Requirements for Public Health Insurance Scheme Participants
The primary duty of every participant is to pay health insurance contributions or to have another premium contributor who pays health insurance contributions on their behalf, or to prove that they qualify for State-insured status.
In addition, all insured persons are obliged to inform about facts that influence the payment of health insurance contributions, such as the fact that a person has ceased to be eligible for State-insured status, the beginning and end of employment, self-employed status, etc.
Moreover, all insured persons must identify themselves using a valid health insurance card issued by their public health insurance fund.
Public Health Insurance Scheme Participants – Main Entitlements
Every participant is entitled to free healthcare services in the Czech Republic to the extent and conditions specified under the Czech legislation.
In addition, every insured person has the right of the free choice of a physician who has a contractual arrangement with their public health insurance fund. Each participant is entitled to receive an overview of provided healthcare and to take part in the inspection of this provided healthcare covered by ZP 211.
Each participant is also entitled to the reimbursement of the above-limit costs of prescribed medicinal products partially reimbursed under the public health insurance scheme.
In the case of receiving urgent healthcare abroad, each participant has the right to apply for reimbursement for the health expenses, but only up to the value of the relevant healthcare services in the Czech Republic.
Likewise, each participant is entitled to apply for reimbursement of costs up to the amount of Czech prices for cross-border healthcare services received in another EU Member State.
Public Health Insurance and the EU
Regarding to EU membership, public health insurance scheme is subject to the European regulations on the coordination of social security systems (EURegulation [EC] No. 883/2004 On the Coordination of Social Security Systems, its Implementing Regulation [EC] No. 987/2009 and the Regulation [EU] No. 1231/2010 extending these regulations to third countries nationals) prior to the Czech legislation.
European regulations on the coordination of social security systems apply both to EFTA countries (Norway, Liechtenstein, Iceland, and Switzerland) and to the United Kingdom (UK) subject to the conditions laid down under the Agreement on the Withdrawal of the UK from the EU and the Trade and Cooperation Agreement between EU and the UK. Under the foregoing regulations, a person may be insured in only one Member State on the basis of the following order of considerations:
- Country where gainful economic activity is carried out (employment or business operations)
- Country where a pension is received (or other cash benefits arising from previous gainful economic activity)
- Country where the breadwinner of a dependent person is insured (i.e. dependent children and spouse are insured in the same country as the breadwinner)
- The actual country of residence of a non-active person
Insured persons staying outside the competent Member State are entitled to the necessary healthcare in EU Member States, EFTA countries, and the UK (at the expense of their competent public health insurance fund), based on a European Health Insurance Card (EHIC). Necessary healthcare shall always be provided in accordance with the conditions of the country where treatment is provided (additional costs of healthcare shall be taken into consideration). A person who has paid the cost of necessary healthcare himself is entitled to get reimbursement from his health insurance fund.
A person residing in another Member State is eligible for full health insurance coverage in the country of residence at the expense of their public health insurance fund.
Where can I receive assistance?
ZP 211 clients can contact any Client Care Centre or send an enquiry to firstname.lastname@example.org.