How to change your health insurance company

What is the legal framework?

The basic regulation is the Public Health Insurance Act, which regulates the system of public health insurance in the Czech Republic – i.e. who is insured, to what extent, what care is covered and under what conditions.

This Act addresses, among other things, the rights and obligations of insured persons and health insurance companies, the scope of covered health services, the network of contracted health service providers and the organisation of the health insurance system as a whole.

It is the Public Health Insurance Act that provides that the insured may choose a health insurance company and, under certain conditions, change it. From the point of view of the average person, it is important that this is not just a matter of the goodwill of the insurance company, but of the legal right to choose a health insurance company, but at the same time the law sets limits to prevent chaotic ‘hopping’ between insurance companies.

Another important regulation is the law on public health insurance premiums. This regulates in particular the amount of public health insurance premiums, the method of payment, penalties, control and maintenance of the central register of insured persons and the redistribution of premiums between health insurance companies. In common parlance, it is often referred to as the ‘Health Insurance Act’. What is important for the average insured person is that this law deals primarily with the payment of insurance premiums, i.e. your obligations as an employee, self-employed person or person with no taxable income. When you change insurance companies, you must see that all payments are made correctly to the new health insurance company.

The third key regulation is the Health Services Act. This focuses in particular on patients’ rights (e.g. informed consent, access to records, choice of provider), the obligations of health professionals and health service providers, medical records and their maintenance, and complaints about the provision of health services. From the point of view of changing the insurance company, it is important that this law regulates the relationship between the patient and the doctor (hospital, outpatient clinic, etc.). If you change health insurance companies, you need to check whether your chosen provider also has a contract with the new insurance company. This links the Public Health Insurance Act ( covered services, contractual network) and the Health Services Act (patient rights, provision of care).

When to change health insurance and how often

The Public Health Insurance Act allows you to change your health insurance company only at specific times. In practice, the way it works nowadays is that the health insurance company is always changed on 1 January or 1 July of the calendar year and the request for change must be submitted three months in advance.

This means that if you want to change your health insurance company on 1 July, you usually have to apply by 31 March. If you want to change on 1 January, you need to be able to apply by 30 September of the previous year.

The specific dates may vary slightly over time (e.g. when deadlines shift or legislation changes), so it is always a good idea to check the current conditions with your chosen health insurer in the Czech Republic.

According to the current rules based on the Public Health Insurance Act and the methodology of insurance companies , it is usually possible to change the health insurance company once every 12 months, always on one of these dates (1 January or 1 July).

The purpose is stability of the system – the state and health insurance companies must plan the flow of premiums and reimbursements to providers. Constantly changing insurance companies would complicate the system significantly.

How to change health insurance companies step by step

Before you even apply, it is a good idea to think about which health insurance company in the Czech Republic is best for you. There are several health insurance companies in the Czech Republic (e.g. VZP, ZPMV, VoZP, ČPZP, OZP, RBP, ZPŠ and others), all of which are part of the public health insurance system and are subject to the same legal rules.

When making your choice, look in particular for:

• network of contracted providers – whether the insurance company has contracts with your doctors (GP, dentist, gynaecologist, specialists),
• the availability of care in your region – hospitals, specialist centres, polyclinics,
• the quality and scope of preventive programmes – contributions for vaccinations, rehabilitation, aids, screenings,
• online services and client zones – e-communication, overview of care drawdown, mobile apps,
• communication and customer service – helpline, email, availability of branches.

Bonuses and marketing promotions are nice, but in the long run, how easy it is to get the health care that is essential to you or your family is more important.

The actual change of insurance company is done by applying to a new health insurance company in the Czech Republic. In practice, you apply to the new insurance company, not the old one, and in most cases the application can be completed online, or in person at a branch or by post,

Typically, you need identification (name, birth number, address), details of your nationality or residence and, if necessary, proof of identity(ID card, passport).

The new health insurer will usually also handle the deregistration with the original insurer for you, so you don’t have to worry about being “stuck between” two insurers. It is still a good idea to keep proof of receipt (e.g. email, branch receipt) so that you have proof in case of a dispute.

Notification of a change of insurance company to your employer or as a self-employed person

When there is a change of health insurance company, the insurance premiums need to respond:

• Employees – are required to inform their employer without undue delay that their insurance company has changed so that the employer will pay the premiums to the new insurance company from the correct date. It is a good idea to notify the change in writing (email, form) to show that you have complied with the obligation.
• Self-employed persons (sole traders) – must notify the new insurer of the change of health insurance company and adjust the payment of advance premiums so that they go to the account of the new insurer with the appropriate variable symbol. The amount of the advance payments is still governed by the Act on Public Health Insurance Premiums.
• Persons with no taxable income (PIP) – must also ensure that their premium payments go correctly to the new health insurance company.

Change of health insurance company for a child or when moving

The legal guardian makes the decision for the child. He or she can change the insurance company in the same way as for himself or herself – by applying to the new health insurance company in the Czech Republic. It is important to provide proof of identity and birth certificate or other proof of relationship to the child, to make sure that the child’s GP and paediatric specialists have a contract with the new insurance company, or to inform the school or kindergarten if they keep records of the insurance company (for example, for school accidents).

For students, it matters who pays the premiums for them. In the case of a dependent child, the state pays the insurance premiums for the student (according to the Public Health Insurance Act and the Insurance Act), but the student can still change insurance companies: he or she must apply to the new insurance company, prove that he or she continues to meet the conditions of a dependent child (studies) and ensure continuity with the existing doctors (practitioner, specialists).

When moving to or from the Czech Republic, the question of whether to be covered by the public health insurance system or to have commercial insurance is often addressed. It depends on the type of stay, the purpose of the stay (employment, study, business) and any international treaties and European regulations. The Public Health Insurance Act and accompanying regulations determine when the obligation to participate in the scheme arises, but specific situations tend to be complicated – a typical case where it is worth consulting a lawyer.

Summary

Changing your health insurance company is your legal right under the Public Health Insurance Act, but it is only possible under strict conditions – usually once every 12 months, always on 1 January or 1 July, and you must apply for a new insurance company about three months in advance. When choosing an insurance company, the key factors are the network of contracted doctors and medical facilities, the availability of care in your region, the quality of prevention programmes, online services and the level of communication, while the various bonuses are rather supplementary. Changing is done by applying to the new insurance company (often online), which will usually also arrange for you to opt out of the original one; it is advisable to keep your confirmation of acceptance. After the change, as an employee, you must immediately inform your employer so that it pays the correct premiums; as a self-employed or self-employed person, you must adjust your advances and payments in accordance with the Public Health Insurance Act. For children, the insurance company is decided by the legal guardian, for students it depends on who pays the premiums, and when moving in or out of the country you need to address whether you should be on the public system or on commercial insurance. The Health Services Act secures your rights as a patient and relates to changing insurance companies by making sure your doctor has a contract with the new insurance company – otherwise you could pay for your care yourself or change doctors. Insurance debts owed to the original insurer are not extinguished by the change of insurer and can be further recovered, so it is advisable to resolve them proactively (e.g. by means of a payment plan) and in complicated situations it is worth contacting a lawyer.