Compulsory health insurance
Who is insured?
The insured is anyone who:
is subject to compulsory health insurance (e.g. an employee, a person who runs a business, a pensioner, a disability pensioner, an unemployed person);
is a family member of the insured person and has been reported for insurance.
In some cases, the status of a family member exempts you from the health insurance obligation.
Example: a student under the age of 26 should only be enrolled in health insurance for study if he/she cannot be enrolled as a family member.
From when you are entitled to benefits
From the time you report for health insurance (whether you pay the premium or not).
Enrolment for health insurance
You are enrolled for health insurance by the payer of your health insurance premium.
The payer of the premium may be, for example
your employer – in the case of an employee,
a school – in case of a student,
the Employment Office – in the case of an unemployed person.
If you are self-employed, you must report to the health insurance institution on your own.
Where to submit the application
The payer submits the application to the Social Insurance Institution (ZUS). The ZUS website provides useful information on how to apply for health insurance and on the basis of assessment and the amount of the health insurance premium.
Notifying a family member about health insurance
If your family members do not have their own title to health insurance – you are obligated to report them. You should notify the payer (e.g. your employer) within 7 days from the occurrence of circumstances which require you to do so (e.g. if your spouse loses his/her job).
Failure to notify your employer of the necessity to notify or de-register a family member from health insurance may result in a fine.
Whom you may report to the health insurance as a family member
A child (your own, spouse’s, adopted, grandchild’s, a foreign child for whom custody has been established, a foreign child within a foster family or a family children’s home):
no age limit – if he/she has a severe disability certificate (or other equally treated certificate);
up to the age of 18 – if not continuing education
until the age of 26 – if he/she continues education (after the age of 26, if he/she is not insured under any other title, he/she should notify the school or university which will be obliged to report him/her to the insurance);
Spouse (husband, wife);
Ascendants who share a household with the insured person (parents, grandparents).
Grandparents may enroll a grandchild in health insurance if the grandchild’s parents are not subject to health insurance or are not entitled to health care benefits under:
Self-employment,
voluntary insurance.
Re-registering for health insurance
If you have not been registered for health insurance although you are entitled to it and you have used the healthcare services, you can be registered retroactively.
Deadlines
You can retroactively register for health insurance:
for 30 days after you have used the health care benefits,
for 30 days after the National Health Fund notifies you that it has started to recover the costs of those benefits from you.
If you apply retroactively for insurance during this period, you will not pay the cost of your treatment.
Deregistration from the health insurance
If you lose your health insurance (e.g., your employment is terminated), you and your family members will be deregistered.
If a family member whom you enrolled in the health insurance has acquired his own title to the insurance or any other circumstances have occurred due to which he lost his status of a family member – you have to notify the premium payer to deregister him. You have 7 days from the occurrence of these circumstances to do so.
