Expat Healthcare Reform: Are You Covered?

Did you know that you could get fined for not being able to show proof of insurance? Or that you lose your insurance if you get fired? Or that, even if you are legally employed and insured here, your spouse and children are not?

Non EU citizens who are not working for companies with branches in the Czech Republic, or don’t have permanent residency status as well as dependents of those that do are not eligible for public health insurance. They have to buy commercial health insurance from one of six Czech insurance companies and these don’t cover everything by a long shot.

Though EU norms state that non EU citizens must be able to purchase insurance with a minimum coverage of 30,000 EUR for the full time of their stay and that it must cover all emergency care, hospital, death or repatriation costs, the system of commercial coverage is full of loopholes. For example, insurers can refuse coverage or refuse to pay for preexisting conditions. Indeed such absurd situations as an insurer refusing to pay for the treatment of a child born prematurely to parents who are legally insured can happen.

This is why several non-profit organizations are calling for foreigners living in the Czech Republic to be included in the national health insurance system. However, Czech insurers as well cabinet and ministry officials strongly oppose the measure. Instead they are calling for a new law that would clearly define the conditions under which insurers provide coverage, prohibit insurers from refusing clients while increasing the amount of coverage and the scope of covered treatments.

Pavel Cižinský, an attorney at the Prague Multicultural Center, says that such a new law will lead to a sharp increase in the cost of commercial coverage.

“The government wants to create a sort of special law whose main goal is to substantially raise the price of commercial insurance. The last attempt to pass such a law called for a minimal fee of 25,000 CZK per year, and up to 50,000 CZK for those with pre-existing conditions,” he said. “Healthy individuals will end up paying the most and it won’t help the ill ones because they won’t be able to afford it anyway.”

Cižinský claims the system of commercial coverage heavily favors insurers.

“Foreigners are forced to purchase health insurance, but no one is setting any standards for the insurers,” he wrote in the January 2015 issue of “Občan v síti” a magazine dealing with civic issues adding that this ambiguity allows insurers to refuse to pay the full amount for care, which ultimately hurts both patients and healthcare facilities.

At present, commercial coverage costs up to 12,000 CZK per year, which is about half the amount a Czech self-employed person would pay in monthly installments. However, the provider can refuse to grant or renew coverage in the case of grave illnesses.

Robert Kareš of the Czech Insurers Association says including foreigners in the public health insurance is a gamble that could overburden the healthcare system. He said that the campaign to include foreigners in the public healthcare system is largely self-serving.

“These organizations are constantly turning up tragic, unique cases of selected foreigners whom it was not possible to cover under commercial coverage due to standing legislation because they had grave illnesses which they generally contracted prior to the closing of an insurance policy,” he wrote in Obcan.

Apparently, most Czechs agree with him. According to a December 2014 STEM poll, 75 percent of Czechs don’t want foreigners to be eligible for public health insurance, because they fear it will lead to “medical tourism” – i.e. that foreigners will travel to the Czech Republic to take advantage of the healthcare system.

At present, all foreigners living in the CR must have medical insurance. EU citizens, employees of a firm with a branch in the CR, and individuals with permanent residency status are eligible for public health insurance. Foreigners who are self-employed, dependents of foreigners legally employed here and individuals who have lost their jobs with a Czech company are not. (This does not apply to individuals insured in another EU state who are in the CR temporarily or citizens of countries with bilateral agreements with the CR.)

Individuals with short term visas can purchase cheaper short term policies which covers only emergency, hospital, outpatient and dental care and repatriation costs for up to 60,000 Euro per incident. Foreigners staying in the CR for more than 90 days who are not eligible for public health insurance must buy commercial medical insurance from one of six national insurance agencies. This includes outpatient, hospital, preventative and pregnancy care with a minimal coverage of 60,000 Euro per incident.

Finance minister Andrej Babiš said he prefers to keep the present system of commercial insurance because foreigners don’t contribute to the system over the long term. He said an amendment correcting failures in the present law will be presented to the cabinet in September.

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