What is health insurance?
Health insurance is insurance against illness, accident, injury, poisoning, life threatening conditions, etc. To take advantage of such insurance a monthly premium (contribution) must be paid.Who can benefit from health care services financed from public funds?
There are two types of insurance in the National Health Fund (NFZ) - mandatory and voluntary. Both groups of insured can take advantage of the public healthcare service on the same principles - what is the NFZ? ->Foreigners who belong to one of the following groups may benefit from public health care services:
- 1. employed in Poland
- In Poland, all legally employed individuals, including foreign nationals, must possess health care coverage, which means that employees may benefit free of charge from public and non-public healthcare services.
- Note: it must be remembered that non-public health services are free only when a given institution or physician has signed a contract with the NFZ.
- It is the employer’s responsibility to provide a new employee with access to health care insurance. The employer registers the new employee with the Social Insurance Institution (what is the Social Insurance Institution (ZUS)?) In order to do so, the employer fills out the insurance registration forms ZUS ZUA (the form is available here) and ZUS ZZA (the form is available here). In the following months, the employer pays the employee's health care contribution to the NFZ.
- 2. family members of insured individuals (including family members of individuals employed in Poland):
- Family members of an insured individual entitled to benefit from the health service on the same principles as the insured person are:
- children (own child, spouse’s child, adopted child, grandchild, a child whose legal representative or surrogate parent is the insured person) – until the child turns 18, or if the child is continuing education - until the child turns 26; if the child is certified as severely disabled there is no age limit;
- spouse;
- parents, grandparents - if they form one household with the insured person.
- The insured person is obligated to register family members with the NFZ if they have no medical insurance (e.g. they are not working). In order to register a family member, family members' personal data must be to the insured person's employer.
- An individual who signs up for the so-called voluntary insurance (see “Voluntary health insurance”), is obligated to register his uninsured family members with the Social Security Institution (ZUS) after signing a voluntary health insurance agreement with the voivodship branch of the NFZ on his own - what is the Social Insurance Institution?)
- 3. refugees (refugee status must be recognised in Poland) and foreigners under subsidiary protection and participants in the 12-month-long integration program in cooperation with the district family assistance center.
- 4. unemployed persons registered at the Labour Office. The insurance may also cover family members of a registered unemployed person not insured under a different title.
- 5. clergymen − health contributions for clergy are paid by the individual clergymen or by the diocese or monastic institution.
- More information on health insurance for clergy is available in the Social Security Institution manual.
- 6. all school-age children and are provided with health care coverage as part of the care services provided by the school, even if the parents' stay on Polish territory is not legalised.
- 7. individuals in custody (in prison or in detention facilities).
- 8. individuals staying on the territory of the Republic of Poland and insured in other EU member states or in EFTA states (Lichtenstein, Iceland, Switzerlandand, Norway).
Other foreigners legally residing in Poland can benefit from public healthcare if they are voluntarily insured. The condition of access to the voluntary health insurance in NFZ is the requirement of legal residence in Poland. This means that the foreigner should have at least a residence permit for a fixed period (See "Voluntary health insurance").
Who pays health insurance contributions?
Every person running his own business (for example a business owner) pays his health premiums on his own (for themselves) - more information on doing business in Poland is available here;Also, people insured voluntarily pay their health premiums on their own (See "Voluntary health insurance").
For other people, the contributions are paid by the relevant institutions / individuals:
- contributions of the legally employed are paid by the employer – more information on working in Poland is available here;
- for individuals performing work under a contract of mandate or other civil law contract, the contribution is paid by the principal - more information on working in Poland is available here
- for the unemployed the contributions are paid by the Labour Office – more information on working in Poland is available here
- health contributions for clergy are paid by the individual clergymen or by the diocese or head of the monastic institution
- contributions for refugees or individuals under subsidiary protection provided they have joined the integration programme is paid for 12 months by the regional family assistance centre.
The amount of the contribution is calculated as a percentage of its base (usually based on income). Every insured person, no matter how high or low the premium, is entitled to the same health care benefits.
Voluntary health insurance
An individual legally residing in Poland and who is not subject to the mandatory healthcare insurance requirement can voluntarily purchase healthcare insurance. In order to do so, the individual must apply to the appropriate voivodship NFZ branch competent for his place of residence - what is the National Health Fund? ->)Contact data for NFZ branches
When applying for voluntary healthcare insurance, foreigners who are not EU citizens must provide their passport and one of the following documents:
- a visa for work;
- a temporary residency permit;
- a permit to settle in Poland;
- a long-term EU resident permit;
- a permit for tolerated stay;
- proof of refugee status issued in Poland or proof of temporary protection in Poland.
After signing a contract with the NFZ, the applicant has to fill out and submit the ZUS ZZA form at an appropriate Social Security Institution (ZUS) branch or inspectorate (the form is available here ->) – what is the Social Security Institution (ZUS)?
The form can be printed out and delivered in person or sent by post to the branch or Social Security Institution inspectorate in the competent district.
Individuals covered by voluntary healthcare insurance are obligated to register for insurance their family members not covered otherwise under obligatory insurance. The family members entitled to this benefit are the same as in the case of obligatory health insurance: children, spouse, as well as parents and grandparents if they form one household with the primary insured person.
In order to apply for benefits for family members, the insured must submit the ZUS ZCNA form to the Social Security Institution (the form is available here ->). The form can be printed out and delivered in person or sent by post. The contributions are then paid into the Social Security Institution account - detailed information is provided by the Social Security Institution (ZUS).
Information about the amount of the contribution is available at the NHF (NFZ) branches or on the website.
Contributions for each calendar month are paid by the 15th day of the next month for the previous month (ex. for April by 15 May).
A foreigner may also take out voluntary insurance in another insurance company, for example the PZU company offers insurance “Wojażer” (Voyager) for foreigners coming toPolandfor a holiday, to study or work.
Proof of health insurance
The following is considered proof of insurance:- current ZUS RMUA document provided by the employer;
- current proof from the place of employment on payment of health care insurance contributions;
- in case of performance of business activity, the health insurance registration form and valid proof of payment of health insurance contributions;
- for the unemployed – valid proof form the Labour Office on being registered for healthcare insurance;
- contract with the NFZ and a document form the Social Security Institution proving registration for healthcare insurance including current proof of payment of contributions in the case of voluntary insurance;
- certification issued by the NFZ or the EHIC (European Health Insurance Card) if the individual is insured in one of the EU or EFTA Member States.
Family members of the insured individual are also requested to provide proof of insurance. Such proof is:
- proof of health care contribution payments including a copy of the insurance registration form (forms ZUS RMUA and ZUS ZCNA - if the registration took place before 1.07.2008 or ZUS ZCZA - if the registration took place after 1.07.2008);
- a current confirmation document issued by the employer;
- a family health booklet stating the personal data of the family members with a current date and stamp of the employer or Social Security Institution (ZUS);
It should be kept in mind that some of the documents listed above such as ZUS RMUA or ZUS ZCNA are only valid for a period of 30 days.
If the insured is unable to provide proof of insurance at the time when the medical service is provided, proof of insurance can be provided no later than within 7 days (or in the case of hospitalization within 30 days from the date of admittance to hospital if the patient remains outside the hospital, or 7 days from termination of the treatment if the patient still remains hospitalized). If proof of insurance is not provided within those deadlines, the patient may be held liable for all costs associated with the medical services provided.
Note!: In the event of an emergency, lack of a document confirming the right to free healthcare can not be used as grounds for refusal to provide treatment!
Expiry of right to healthcare services
The right to healthcare services usually expires after 30 days from termination of the insurance coverage obligation; for example:- 30 days from termination of an employment contract;
- 30 from the demise of an insured person whose family members were covered under their insurance; the above family members lose their entitlement under this title.
In the case of voluntary healthcare insurance, the right to healthcare benefits expires at the time of termination of the agreement with the NFZ or within a month if arrears in contribution payments arise. In case of persons insured voluntarily by insurers other than the NFZ, the contract signed with the insurance company specifies when the right to benefits expires.
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