He alth insurance is a he althcare service that aims to protect human he alth. As part of the insurance, everyone has the right to treatment, rehabilitation, staying in a hospital, spa and he alth prophylaxis. In Poland, he alth insurance is divided into compulsory and voluntary. Many people also pay for private medical subscriptions, thanks to which, among others, they gain access to many specialists much faster. Find out who is covered by compulsory he alth insurance and who should pay it voluntarily. What else is worth knowing about he alth insurance?
He alth insuranceis a he althcare service that guarantees everyone access to he althcare. Insured persons, i.e. persons who pay contributions or who meet the conditions specified in the Act (which is provided for in Journal of Laws of 2015, item 581 as amended), have the right to medical consultations, hospital care, rehabilitation, stay in a spa or laboratory tests. The he alth insurance contribution is transferred to the Social Insurance Institution (ZUS), and then to the National He alth Fund (NFZ). He alth insurance can be divided into
- compulsory he alth insurance
- voluntary he alth insurance
Compulsory he alth insurance
Compulsory he alth insurance is available, among others :
- people employed under an employment contract or mandate
- for people running a business
- farmers
- unemployed registered in the Labor Office
- people receiving permanent social welfare benefits
- soldiers, policemen, ABW officers and others
- to deputies, senators, judges
- pensioners
- pupils and students
- people on parental leave
- and many others
Compulsory he alth insurance means that if a person is covered by the above criteria, they are en titled to insurance.
For example, if she is employed under an employment contract or mandate, the employer is obliged to report her to ZUS and pay contributions from her salary.
The university has the same obligation to pay contributions, as well as the Employment Office towards the unemployed.
The insurance starts working with this notification, and usually ends 30 days after its expiry, but there are various exceptions. For example, if the student is insured by the university, the right to he alth benefits ceases only 4 months after the insurance expires (graduation).
Voluntary he alth insurance
People who do not meet the above conditions may pay for their own he alth insurance. For this purpose, an individual contract with the NFZ should be signed for an indefinite period (it can be terminated at any time - e.g. when we take up employment under an employment contract).
You need an identity document and, for example, a certificate of employment from your last place of employment or a decision to terminate / suspend your business.
After signing the contract, you must go to your ZUS branch in order to register for voluntary he alth insurance. Then the amount of the contribution will be calculated, which must be paid regularly and that's it.
A voluntarily insured person should also register family members who are not en titled to this insurance for he alth insurance. It does not require paying an additional premium.
Of course, there is no obligation to pay for voluntary he alth insurance, but you should take into account the fact that all medical services, medical consultations, laboratory tests or hospital stay, in case of which you will have to pay "out of pocket".
In addition, when, in a few months or years, we want to start paying he alth insurance contributions again, the National He alth Fund will demand that the arrears be settled.
Who can pay for voluntary he alth insurance?
- persons who are not covered by the he alth insurance obligation in Poland, in the European Union and in a member state of the European Free Trade Association (EFTA), if they live in Poland
- people who are not covered by compulsory he alth insurance for their work are not insured by universities or elsewhere. They are also not reported for insurance as family members of the insured person
- volunteers
Family members insurance
You can register your closest family members for insurance:
- husband or wife
- your or your spouse's child, as well as an adopted child, until they turn 18, and if they continue their education - until they are 26
- parents and grandparents, if they stay with the insured person in the same household
Grandparents can tooregister a grandson for insurance, if none of his parents is:
- compulsorily covered by he alth insurance
- en titled to benefits under the coordination provisions for work or self-employment
- covered by voluntary he alth insurance
The he alth insurance of a family member guarantees him exactly the same scope of benefits as the insured person has. It also does not increase the amount of the premium.
How much does he alth insurance cost?
The amount of the he alth insurance contribution is 9% of the average monthly salary. According to the Central Statistical Office, in 2022 it amounts to PLN 319.94. The amount of the contribution for voluntary he alth insurance changes every quarter and in the first quarter of 2022, it is PLN 426.59.
Discontinuity of insurance
It is worth maintaining the continuity of paying he alth insurance contributions, because each break causes an increase in debt to the National He alth Fund. If you have been uninsured for a long time, you must pay the amount if you want to re-join the insurance.
In case of a break lasting:
- from 3 months to a year - this is 20% of the contribution base and must be paid in full
- in the event of a break from one to two years - 50% of income, the fee may be spread over a maximum of 3 installments
- in the event of a break from 2 to 5 years - 100% of income, the possibility of dividing it into 6 installments
- in the event of a break from 5 to 10 years - 150% of income, the fee may be spread over 9 installments
- in the event of a break of over 10 years - 200% of income, the possibility of dividing it into 12 installments
In the fourth quarter of 2022 it was respectively:
- from 3 months to 1 year - not less than PLN 947.98
- 1 to 2 years - not less than PLN 2,369.96
- 2 to 5 years - not less than PLN 4 739.91
- 5 to 10 years - not less than PLN 7 109.87
- over 10 years old - not less than PLN 9,479.82
The National He alth Fund allows re-insurance only after the payment of the amount due.
Why do you have to pay this debt at all? Well … it could happen that someone would insure themselves only to undergo treatment, rehabilitation or hospitalization, and immediately resign from insurance upon completion.
ImportantNOTE
From January 1, 2022, ZUS introduced a novelty. From now on, each payment of due contributions will be settled for the oldest arrears. If you applied for voluntary he alth insurance and you have arrears on your account, your payment will first settle the arrears with interest, andonly then the current contributions. So you will not be able to pay your current contributions until you have paid the arrears. This may result in you not being en titled to Child Benefit in the event of sickness or maternity.
Private he alth insurance
Many non-public medical centers offer special packages for private medical care.
Private packages are much narrower than what the National He alth Fund offers us.
We can also take advantage of he alth insurance from an insurance company. Unlike the public he alth service, the private one offers a much higher level of patient (client) service, and above all, quick access to specialists (e.g. instead of six months, we have an appointment in two days).
Depending on the amount of the subscription, we also get a different range of benefits. If we can afford private insurance, it will definitely be beneficial for us, but it is not worth choosing only such a solution.
Sources:
- http: //www.zus.pl/pracujacy/ubbezpieczenie-zdrowotne-w-polsce/zasady-podlegania-ubbezpieczeniu-zdrowotniczego/ubbezpieczenie-obowiazkowe