Law 580/2004 The Z. z. o. on health insurance (hereinafter referred to as "the Act') provides, in § 9, certain restrictions on the reimbursement of healthcare provided to the debtors of the health insurance undertaking. Due to the fact that according to the knowledge of application practice there is uncertainty in this connection, the Ministry of Health of the Slovak Republic issues the following guidance.
Who's the borrower?
Debtor is a person published in the debtors' list
The definition of the debtor is laid down in Article 25a (1) of the Law.
For the purposes of this Act, a debtor shall be an insured person or an insured person against whom, on the date of publication of the list of debtors, a claim for an advance on an insurance premium at least for a period of three months is registered by the competent health insurance undertaking for a payment or claim on the insurance premium which he was required to pay from the date of the establishment of the public health insurance fund until the date of the application's confirmation by the competent health insurance undertaking, for a total amount exceeding EUR 100.
The debtor should be published in the list of debtors according to § 25a (2) of the Act.
Does each debtor have a limited entitlement to health care?
No. The part of debtors (who meet the conditions specified by law) is entitled to full reimbursement of healthcare.
The Law in § 9 (2) specifies specific groups of debtors who are entitled to full reimbursement of healthcare
It is the debtor:
(a) which has been authorised by the health insurance undertaking to pay the sums due;
(b) from which the outstanding insurance premiums are recovered in enforcement proceedings, paid in instalments and notified to the health insurance undertaking;
(c) assets which have been declared bankrupt or which have been authorised to restructure;
d) which successfully objected to the statute of limitations on the debt for which it was kept in the list of debtors;
(e) which has been ordered by a court to protect it;
f) which is an employee for whom he has not paid an advance on the insurance employer;
(g) to which the payment schedule under the bankruptcy and restructuring law has been determined;
h) which was included in the programme of the Ministry of the Interior of the Slovak Republic to support and protect victims of trafficking in human beings.
The health insurance undertaking has a legal obligation under § 25a (2) (a). (a) state clearly in the list of debtors that the debtor is entitled to full reimbursement.
Debtors who are not entitled to full reimbursement of healthcare are only covered by urgent healthcare?
No. The coverage of healthcare is much wider; e.g. general outpatient healthcare should be fully paid to debtors without restriction
The extent of the health care paid for by each debtor is determined by Paragraph 9 (8) of the Act. These are:
a) urgent health care;
b) pregnancy-related health care;
c) vaccination to prevent infectious diseases;
(d) treatment of infectious disease,
e) healthcare provided for the purpose of diagnosing and treating chronic disease (patients in the dispensary);
(f) nursing care provided through a home nursing agency or through a social services establishment within the scope of nursing practice provided by a nurse or midwife in accordance with a special provision, where the use of medicinal products and specialised medical supplies not subject to prescription is made;
g) general outpatient care.
In this context, we would like to draw the attention of healthcare providers to the fact that they cannot refuse to provide the health care referred to above solely because the person is published on the debtors' list, as the debtors are also legally entitled to this healthcare.
Should the application practice refuse to pay the above health care by the health insurance company with a reminder that it is a debtor (or if there are administrative or technical barriers on the part of the health insurance company that do not allow the provider to apply for such healthcare provided to the debtor) we allow healthcare providers to request notification of such a situation, including specific details, either to the Ministry of Health of the Slovak Republic or to the Health Care Supervisory Authority which supervises compliance with the provisions of the law.