Health insurance in 2026 – who has to pay it?

Quick overview

• Almost everyone in the Czech Republic has to pay health insurance.
• Employees are covered by their employer, self-employed people pay their own insurance.
• The state pays for children, pensioners or parents on parental leave.
• If you don’t pay the insurance, you incur a debt and a penalty, but your right to healthcare is not lost.
• The amount of the minimum contribution varies each year according to the average wage.

Not sure who should pay health insurance in your situation, or are you dealing with a debt with the insurance company? We’ll take a look at your case and recommend the quickest solution.

What is public health insurance

Public health insurance is a mandatory insurance used to pay for health care for the insured. Its rules are regulated by the Public Health Insurance Act. Health insurance is based on the relationship between the recipient of healthcare (i.e. the insured), the healthcare intermediary (e.g. doctor, hospital, etc.) and the healthcare payer (i.e. the insurance company).

There are a total of seven health insurance companies in the Czech Republic, from which the insured can freely choose.

Public health insurance is mainly regulated by the Act on Public Health Insurance and the Act on Public Health Insurance Premium. These regulations determine the range of insured persons, the amount of premiums and the rules for paying advances and penalties.

When does health insurance arise

Health insurance arises when:

1. automatically to all persons on the day of their birth if they are also permanent residents of the Czech Republic.
2. to a person who has acquired the right to reside permanently in the territory of the Czech Republic, or if the person has been entrusted to the care of a person who is registered for permanent residence in the Czech Republic;
3. other persons without permanent residence under certain conditions (e.g. people working in the Czech Republic, people with a residence permit for the purpose of scientific research, asylum seekers, etc.).

Health insurance does not apply to Czech citizens who have been abroad for more than 6 months and have informed their health insurance company of this situation.

What health insurance pays for

What exactly is covered by health insurance is defined in the Public Health Insurance Act as follows: Health insurance covers health services provided to an insured person to improve or maintain his or her health or to alleviate his or her suffering if:

• they are appropriate to the insured’s state of health and the purpose to be achieved by their provision, and they are reasonably safe for the insured,
• they are in accordance with current available medical science,
• there is evidence of their effectiveness in relation to the purpose for which they are provided.

In practice, these include preventive healthcare, reimbursement of some or part of medication, rehabilitation and spa treatment, basic dental care, blood and other samples, hospital stays, transport for medical purposes, certain vaccines or, under certain conditions, artificial insemination.

Who has to pay health insurance

Every citizen of the Czech Republic, including children and pensioners, must pay health insurance. However, some groups do not pay insurance themselves, but the state pays for them. The payers of the insurance premiums fall into three categories:

• Insured persons: this includes employees for whom their employer pays health insurance, self-employed persons who pay for their own insurance, and persons without taxable income who are not registered with the Labour Office as jobseekers.

• Employers: Employers are obliged to pay health insurance for their employees. 1/3 is paid by the employee and 2/3 by the employer.

• State: The state pays for insurance for certain groups of people. This includes dependent children, pensioners, women on maternity leave, persons on parental leave, recipients of parental allowance, persons registered with the employment office as job seekers, persons receiving material need assistance benefits, persons dependent on and caring for another person from the second degree of dependence, persons of retirement age without a retirement pension and persons providing full-time care for children. If these persons also earn income in employment or as self-employed persons, health insurance is paid partly by the state and partly by the insured persons themselves.

How much does health insurance cost

There are different minimum health insurance premiums for each group of payers:

• Self-employed persons: the health insurance advance paid by self-employed persons is based on the minimum assessment base, which is determined as 12 times the average wage in the national economy (calculated from all wages of Czech workers). As these are advance payments, the total sum at the end of the year may result in an underpayment or overpayment of health insurance. The underpayment must then be paid within 8 days of the submission of the statement. The insurance company will only refund the overpayment if it is more than CZK 200 within one month of the overpayment being discovered. A common problem for entrepreneurs is the wrong amount of advance payments. Many self-employed persons only discover the underpayment after submitting a report to the health insurance company. In some cases, the debt then grows by thousands of crowns in penalties within a few months.
• The state: The amount paid by the state on behalf of the insured is regulated by a government regulation from the previous year.
• PERSON: Persons without taxable income pay 13.5% of the minimum assessment base.
• Employee/employer: The employer pays 13.5% of the assessment base for the employee. One third is deducted from the employee’s wages and two thirds is paid out of the employee’s own resources.

When and where to pay health insurance

Again, health insurance is paid differently for each group of payers:

• Self-employed persons: self-employed persons pay their advance payments for health insurance by the 8th of the following month (e.g. for January, payment must be made no later than 8 February). The insurance is paid to your health insurance company with the variable symbol assigned to you or, in the case of a lump sum, to the tax administration.
• PWD: PWDs are also obliged to pay their health insurance directly to their health insurance company by the 8th of the following month. The variable symbol in this case is your insurance number or special insurance number.
• Employee/employer: the employee does not have to deal with when and where to pay the health insurance, as his/her employer deals with this for him/her. The employer must therefore always pay the insurance by the 20th of the following month to the employee’s health insurance company. In addition, they also have to report the premium payments to all their employees’ insurers every month.

What if you don’t pay health insurance

It is always compulsory to pay health insurance. So if your employer or the state does not pay it for you, you must pay it yourself. The good news is that even if you don’t pay health insurance, you are still entitled to free healthcare. But that doesn’t mean it’s worth not paying.

Because if you don’t pay, you will incur a debt and a penalty of 0.0403 per cent of the amount you owe. The insurance company should inform you of this debt and you should start addressing it as soon as possible.

Insurance companies are often willing to agree to a payment plan, and in some cases will even forgive all or part of the penalty. But you need to take action and not ignore the debt. Otherwise, you may get a visit from the bailiff.

In practice, we often see situations where people discover they owe health insurance only after several years – typically after returning from abroad or after closing their business. The most common mistake is not notifying the insurance company of the change in their situation or mistakenly believing that the state pays the premiums for them.

One of our clients did not address the change of her insurance category for several months after her parental leave. She believed that the state continued to pay her premiums. After two years, the health insurance company assessed her a debt including penalties. Eventually, she managed to negotiate a repayment plan and a partial waiver of the penalty.

If you have already received a notice from the insurance company or a garnishment, it is worth dealing with the situation as soon as possible. In many cases, it is possible to arrange for repayments or a reduction of the penalty. We can help you.

Employer does not pay health insurance

As an employee, you may find that your employer will not pay for your health insurance. Fortunately for you, you are off the hook as an employee and will not be affected by any debts or penalties. Everything in this case is up to the employer. However, it is a good idea to inform your health insurance company of this situation.

In practice, employees often only find out about the problem when they are contacted by their health insurance company. Although the employer is liable for the unpaid premiums, it is advisable to deal with the situation proactively and check whether the employer is actually sending the contributions.

Summary

Health insurance is compulsory for almost everyone in the Czech Republic. Employees are covered by their employer, business owners pay the premiums themselves, and the state pays for some groups of the population. The amount of minimum payments changes every year and non-payment incurs debt and penalties. Although entitlement to healthcare does not cease, it is worth tackling the debt as soon as possible – ideally before a foreclosure occurs.