Public health insurance is mandatory for all persons who have their permanent residency in the Czech Republic or who work for an employer with a registered office or permanent a residency in the Czech Republic.
Certain foreign nationals who are, in accordance with the related Czech legislation, considered to have permanent residency in the Czech Republic are also covered by the public health insurance scheme, including foreign nationals with a long-term residency permit for the purpose of scientific research, foreigners who are international protection applicants, foreign nationals being tolerated in the Czech territory, foreign nationals granted temporary protection, asylum seekers, new-born children whose mother has the long-term residency permit in the Czech Republic and persons under the age of 18 who have a valid permit for a long-term residency in the Czech Republic.
Participation in the public health insurance scheme becomes mandatory from the beginning of permanent residence or upon starting employment in the Czech Republic.
Every person participating in the public health insurance scheme is required to pay health insurance contributions.
Because of the country’s EU membership and also certain international social security treaties, participation in the Czech public health insurance scheme also becomes mandatory for EU nationals (and certain foreign nationals) who have gainful economic activity in the Czech Republic, regardless of whether they are employees or self-employed. In accordance with EU Regulation No. 883/2004 On the Coordination of Social Security Systems, Czech public health insurance scheme might also apply to pensioners receiving a pension in the Czech Republic, family members of persons undertaking gainful economic activity and being insured in the Czech Republic, and also non-active persons who have their place of residence or a centre of interest in the Czech Republic.
For certain groups of persons, health insurance contributions are paid by the State. These State-insured participants are not required to pay health insurance contributions. This mainly includes dependent children and students up to the age of 26 years, women on maternity or parental leave, persons receiving a parental allowance, senior citizens (recipients of benefits under the Czech old-age pension scheme) etc. (For additional information, see the question: “For which persons does the State pay health insurance contributions?”)
Each participant has the right to choose a public health insurance fund, with the exception of new-born children, who are registered with the same public health insurance fund as their mother. In addition, every person has a right to transfer to another public health insurance fund once in every 12 months.
It is compulsory for each participant to prove their insurance by a valid health insurance card or a provisional replacement certificate when receiving medical treatment. In the case of a lost or stolen health insurance card, it is necessary to contact the competent Czech insurance fund as soon as possible and apply for a replacement card.
All participants of a public health insurance scheme are obliged to inform their public health insurance fund of any change of facts relevant for paying health insurance contributions and for their participation in the public health insurance scheme.
Health insurance in brief
How to become a participant in the public health insurance scheme in the Czech Republic?
- On the basis of permanent residence in the Czech Republic
- Upon starting employment with an employer that has its registered office or permanent residence in the Czech Republic
- In cases of children born in the Czech territory to mother with a long-term residence permit in the Czech Republic
- In cases of persons under the age of 18 who have a valid permit for a long-term residence in the Czech Republic
- In cases where a person is considered to have permanent residence in the Czech Republic based on the relevant Czech legislation
- On the basis of EU Regulation No. 883/2004 On the Coordination of Social Security Systems (for additional information, see “Health Insurance and the EU”)
- On the basis of certain international social security treaties signed by the Czech Republic, covering health insurance (Albania, Montenegro, Serbia, North Macedonia, Syria, Tunisia, Turkey, Japan, Israel, and the USA).
Who pays public health insurance contributions?
Each participant of the public health insurance scheme in the Czech Republic is obliged to pay health insurance contributions. The payment depends on the classification of the insured person:
- Self-payer (person with no taxable income)
- State-insured person (the State pays contributions on behalf of certain groups of participants)
- Employee (health insurance contributions are paid by the employer and the employer must also report the relevant data to the competent health insurance fund)
- Self-employed person
- Legal guardians of a new-born child who is eligible to be insured within the scheme based on mother´s long-term residence permit
- Legal quardians of a person under the age of 18 who have a valid permit for a long-term residence in the Czech Republic
For whom does the State pay health insurance contributions?
These groups of participants are State-insured persons and their contributions are paid by the government (State):
- Dependent children up to the age of 15 years, students up to the age of 26 years, and students attending in-house doctoral programmes
- Beneficiaries of benefits disbursed under the Czech Republic’s old-age pension scheme or persons who have reached retirement age but are not eligible to receive pension benefits (persons who do not receive a pension from abroad in the amount of the minimum wage or higher), or beneficiaries of pre-pension benefits under a supplementary retirement savings plan (subject to requirements laid down in the law)
- Beneficiaries of parental allowance, maternity allowance, women on maternity leave, and persons on parental leave
- Job-seekers registered with a Labour Office
- Recipients of benefits in Material Need and jointly assessed persons
- Recipients of sickness in cash benefits
- Disabled persons with medium or full dependence on another person’s care and persons caring for such dependent persons, persons caring for children up to the age of 10 years with minor dependence on another person’s care
- Persons subject to protective detention, pre-trial custody, serving a prison sentence, receiving protective institutional treatment, juvenile persons subject to institutional or protective custody
- Fully disabled persons not eligible for a disability pension
- Persons caring for one child aged up to 7 years of age or two children aged up to 15 years of age on a full-time basis
- Persons working as volunteers on a long-term basis
- Spouses and legally recognised partners of government employees assigned to a position abroad
Persons granted a residence permit in the Czech Republic for the purpose of temporary protection, applicants for international protection and their children born in the Czech Republic, and foreign nationals whose residence in the Czech Republic has been accepted and their children have been born in the Czech Republic.
Requirements for Public Health Insurance Scheme Participants
The primary duty of every participant is to pay health insurance contributions or to have another premium contributor who pays health insurance contributions on their behalf, or to prove that they qualify for State-insured status.
In addition, all insured persons are obliged to inform about facts that influence the payment of health insurance contributions, such as the fact that a person has ceased to be eligible for State-insured status, the beginning and end of employment, self-employed status, etc.
Moreover, all insured persons must identify themselves using a valid health insurance card issued by their public health insurance fund.
Public Health Insurance Scheme Participants – Main Entitlements
Every participant is entitled to free healthcare services in the Czech Republic to the extent and conditions specified under the Czech legislation.
In addition, every insured person has the right of the free choice of a physician who has a contractual arrangement with their public health insurance fund. Each participant is entitled to receive an overview of provided healthcare and to take part in the inspection of this provided healthcare.
Each participant is also entitled to the reimbursement of the above-limit costs of prescribed medicinal products partially reimbursed under the public health insurance scheme.
In the case of receiving urgent healthcare abroad, each participant has the right to apply for reimbursement for the health expenses, but only up to the value of the relevant healthcare services in the Czech Republic.
Likewise, each participant is entitled to apply for reimbursement of costs up to the amount of Czech prices for cross-border healthcare services received in another EU Member State.
Public Health Insurance and the EU
Regarding to EU membership, public health insurance scheme is subject to the European regulations on the coordination of social security systems (EURegulation [EC] No. 883/2004 On the Coordination of Social Security Systems, its Implementing Regulation [EC] No. 987/2009 and the Regulation [EU] No. 1231/2010 extending these regulations to third countries nationals) prior to the Czech legislation.
European regulations on the coordination of social security systems apply both to EFTA countries (Norway, Liechtenstein, Iceland, and Switzerland) and to the United Kingdom (UK) subject to the conditions laid down under the Agreement on the Withdrawal of the UK from the EU and the Trade and Cooperation Agreement between EU and the UK. Under the foregoing regulations, a person may be insured in only one Member State on the basis of the following order of considerations:
- Country where gainful economic activity is carried out (employment or business operations)
- Country where a pension is received (or other cash benefits arising from previous gainful economic activity)
- Country where the breadwinner of a dependent person is insured (i.e. dependent children and spouse are insured in the same country as the breadwinner)
- The actual country of residence of a non-active person
Insured persons staying outside the competent Member State are entitled to the necessary healthcare in EU Member States, EFTA countries, and the UK (at the expense of their competent public health insurance fund), based on a European Health Insurance Card (EHIC). Necessary healthcare shall always be provided in accordance with the conditions of the country where treatment is provided (additional costs of healthcare shall be taken into consideration). A person who has paid the cost of necessary healthcare himself is entitled to get reimbursement from his health insurance fund.
A person residing in another Member State is eligible for full health insurance coverage in the country of residence at the expense of their public health insurance fund.
How is the premium for the public health insurance calculated?
Contributions for the Czech public health insurance scheme are equal to 13.5% of the assessment base. The assessment base varies by the category of contributor. The premium therefore differs for:
- An employee
- A self-employed person (OSVČ)
- A person without taxable income (self-payer)
- A State-insured person
- A Legal representative of a minor child.
1. Health Insurance Contributions of Employees
Starting on 1 January 2024, the minimum monthly health insurance contribution of employees amounts to CZK 2,552. This amount is equal to 13.5% of the minimum wage, which is set at CZK 18,900.
The health insurance contributions of employees are paid by the employer to the competent health insurance fund. Employment is considered to include such arrangements as casual work contracts and multiple casual work contracts with a single payer, the value of which is in excess of CZK 10,000 per month, and also work performance agreements where the gross income is in excess of CZK 4,000 per month. If the assessment base is lower than the minimum wage, the employee must pay 13.5% of the difference between the two through their employer.
Employers pay health insurance contributions (premium) for each calendar month. These are to be paid between the 1st and 20th day of the subsequent calendar month. Health insurance contributions must be credited to the health insurance fund’s bank account within this prescribed time limit.
Employees whose employer has a registered office or permanent address in another EU Member State, in an EFTA country, or in the UK, where the Czech Republic is determined as the country of insurance (under Regulation (EC) No 883/2004 or under the Trade and Cooperation Agreement between the EU and the UK), are also required to register for health insurance and to pay health insurance contributions in the Czech Republic. To that end, a Business ID (IČ) shall be issued to the employer (in case of not having a Business ID), for the purposes of identification and payment of health insurance contributions for their employees.
An employee themselves can take over responsibility for paying health insurance contributions on behalf of their foreign employer based on a written agreement with the employer and a written authorisation to that effect.
2. Health Insurance Contributions of Self-Employed Persons (OSVČ)
Self-employed persons pay health insurance contributions by means of prepayments and an annual settlement.
Starting on 1 January 2024, the minimum amount of prepayments (premium) paid by self-employed persons is CZK 2,968 per month.
For the purposes of calculating prepayments for health insurance contributions and carrying out an annual settlement of payments, self-employed persons must submit to their health insurance company a Statement of Business Revenues and Expenditures (Přehled OSVČ) no later than one month after the deadline for filing an income tax return for the applicable calendar year. The Statement of Business Revenues and Expenditures is used to calculate monthly prepayments for health insurance contributions which self-employed persons must pay to their health insurance company. Where applicable, a self-employed person must pay the outstanding balance of health insurance contributions in cases defined under the law.
Self-employed persons subject to the flat-rate tax regimen must proceed in accordance with the Income Tax Act. A self-employed person whose income tax for 2023 is equal to the flat-rate tax is not required to pay prepayments for health insurance contributions to their health insurance company.
The prepayments of health insurance contributions of self-employed persons are to be paid between the 1st day of the applicable calendar month and the 8th day of the subsequent month. Where applicable, a self-employed person must pay any outstanding balance of health insurance contributions within 8 days after filing a Statement of Business Revenues and Expenditures for the applicable calendar year. Health insurance contributions must be credited to the health insurance company’s bank account within the prescribed time limit.
3. Health Insurance Contributions of Persons with No Taxable Income
Considered a person with no taxable income (OBZP), a self-payer is every person participating in the public health insurance scheme in the Czech Republic who is not an employee, a self-employed person, or a State-insured person in the course of an entire calendar month.
Starting on 1 January 2024, the amount of monthly health insurance contributions paid by persons with no taxable income is CZK 2,552.
Health insurance contributions paid by persons with no taxable income must be paid between the 1st day of the applicable calendar month and the 8th day of the subsequent month, or on the first working day after such a day where applicable. Health insurance contributions must be credited to the health insurance company’s bank account within the prescribed time limit.
4. Health Insurance Premium for State-insured Persons
Starting on 1 January 2021, the assessment base for government-insured persons is CZK 15,440. The value of monthly health insurance premium for government-insured persons is CZK 2,085.
5. Health Insurance Contributions for Children
Starting on 1 January 2024 the premiums are paid by the legal representative for children born in the Czech Republic to a mother with a long-term residence in the Czech Republic and for children under the age of 18 who have a valid permit for a long-term residence in the Czech Republic.
The insurance contributions for children is paid for the entire calendar months.
Health insurance contributions paid by legal representative must be paid between the 1st day of the applicable calendar month and the 8th day of the subsequent month, or on the first working day after such a day where applicable.
Health insurance contributions must be credited to the health insurance company’s bank account within the prescribed time limit.
The amount of monthly health insurance contributions paid by legal representative for child is CZK 2,552.