145/2017 Sb.
LAW
of 20 December. April 2017,
amending Act 592/1992 Coll., on public health
insurance, as amended
Parliament has passed the following Act of the United States:
Article. (I)
Act 592/1992 Coll., on public health insurance, in
amended by Act No. 10/1993 Coll., Act No. 15/1993 Coll., Act No. 161/1993
Coll., Act No. 324/1993 Coll., Act No. 42/1994 Coll., Act No. 241/1994
Coll., Act No. 59/1995 Coll., Act No. 149/1996 Coll., Act No. 48/1997
Coll., Act No. 127/1998 Coll., Act No. 29/2000 Coll., Act No. 118/2000
Coll., Act No. 258/2000 Coll., Act No. 492/2000 Coll., Act No. 138/2001
Coll., Act No. 49/2002 Coll., Act No. 176/2002 Coll., Act No. 424/2003
Coll., Act No. 437/2003 Coll., Act No. 455/2003 Coll., Act No. 53/2004
Coll., Act No. 438/2004 Coll., Act No. 123/2005 Coll., Act No. 381/2005
Coll., Act No. 413/2005 Coll., Act No. 545/2005 Coll., Act No. 62/2006
Coll., Act No. 117/2006 Coll., Act No. 189/2006 Coll., Act No. 214/2006
Coll., Act No. 264/2006 Coll., Act No. 261/2007 Coll., Act No. 296/2007
Coll., Act No. 306/2008 Coll., Act No. 227/2009 Coll., Act No. 281/2009
Coll., Act No. 285/2009 Coll., Act No. 362/2009 Coll., Act No. 73/2011
Coll., Act No. 138/2011 Coll., Act No. 298/2011 Coll., Act No. 329/2011
Coll., Act No. 369/2011 Coll., Act No. 458/2011 Coll., Act No. 401/2012
Coll., Act No. 500/2012 Coll., Act No. 11/2013 Coll., legal measures
Senate, no. 342/2013 Coll., legal measures the Senate No. 344/2013 Coll.
Act No. 109/2014 Coll., Act No. 250/2014 Coll., Act No. 267/2014 Coll.
and Act No. 200/2015 Coll., is amended as follows:
1. In the title of § 1, the word "purpose" shall be replaced by "subject".
2. In paragraph 1, the words "registration of payers of insurance" shall be replaced by
"the central register of insured persons, the redistribution of insurance".
3. In article 3, paragraph 3. 1 the words "the judges ^ 55) that" shall be replaced by
"the judges ^ 55) that".
4. section 20 of the title:
"section 20
General provisions on the allocation of
(1) the general health insurance company of the United States establishes and manages the
special account for public health insurance (hereinafter referred to as "special
account "). Special account is used for redistribution of premiums and other
the income of the special account. General health insurance company of the United States
(hereinafter referred to as "Manager of the special account") leads a special account separate from the
other accounts and funds that it manages.
(2) the subject of redistribution is selected all health insurance
insurance companies and the income of the special account, which are
and the total payment to the State for) an insured person, for which the State is liable for
insurance premiums,
(b)) other transactions which are based on this Act or special
the legislation of the income of the special account, and
(c)) interest credited to a special account.
(3) the resources of the special account shall be paid to the cost of his leadership and on the
accounting operations. The sum of these costs reduces the total amount
to the redistribution (hereinafter referred to as "the amount allocated to the redistribution").
(4) the Redistribution is performed according to the indexes and by costly paid
services.
(5) the redistribution by means of monthly indices of redistribution
individual health insurance premiums by cost indexes
age groups and pharmaceutical and-cost groups and according to the corrections for the
overlapping groups according to § 21. Age group means each of
cost policy holders age groups referred to in annex 1 to the
This Act. Oil and drug cartel-cost group means the cost
the group to which they are assigned according to the consumption of medicinal products
insured persons with disease in the chronic stage. The cost index of age
Group and the oil and drug cartel-the cost group expressed in nonstop
connection with the jurisdiction of the insured person to the group, different
the estimated annual cost of paid services such insured person
compared to the estimated average annual cost of one of the insured person in
public health insurance system. The cost index of the insured person
It expresses how many times the estimated annual cost of paid services
the insured person different from the implied average annual cost
one of the insured in the public health insurance system. To
the average cost of one of the insured person in a public
health insurance costs are not included, which are subject to
redistribution pursuant to paragraph 6. The method of calculation of the cost index
the insured person modifies the annex 2 to this Act.
(6) the redistribution by costly covered services means the monthly
advance insurance individual health insurance redistribution
pursuant to section 21a of the annual billing in accordance with § 21 c, carried out under the
nationality of insured persons to health insurance company, for which the following
health insurance companies paid for expensive paid services.
(7) the health insurance fund for the purposes of redistribution are appreciated by the way
laid down in the implementing regulation issued pursuant to § AWACS (e). (d))
the cost of health services reported to the provider of health services
for the previous calendar year. ".
5. in section 20, the following new section 20a to 20 c, which including the following title:
"The system of redistribution
section 20a
(1) the amount designated to the redistribution of special administrator redistributes
between health insurance account according to the variable parameters
redistribution, which are adjustable parameters and redistribution
the calculated parameters of redistribution. Procedure for determining the variable
parameters is given in annex 2 to this Act.
(2) the Adjustable parameters of the redistribution are
and pharmaceutical and-cost) list of groups; for a list of
oil and drug cartel-cost group contains the oil and drug cartel-the cost
the group included in the redistribution the redistribution for the period
and the rules under which the insured persons are classified into these groups,
(b)) the list of age groups with the oil and drug cartel-cost group
and two of the oil and drug cartel-cost groups to each other (hereinafter referred to as "the combination of
groups "), which provides for that combination of groups will be calculated
correction for overlapping groups,
(c) the coefficient for the calculation of the hedge) constants, establishing the volume of
resources that will be přerozdělovány in a redistribution under the
expensive paid services, and
(d) the consumption of drugs for border) classification of the insured person to
oil and drug cartel-the cost group that indicates the minimum consumption
the usual daily therapeutic doses of medicinal products required for the
the inclusion of the insured person to the oil and drug cartel-the cost of the group by list
oil and drug cartel-cost groups.
(3) the Calculated parameters of the redistribution are
cost indexes) age groups and pharmaceutical and-cost groups,
(b)) correction for overlapping groups, if determined combinations of groups,
for which the correction is to be calculated; correction for overlapping groups
means a shipping index that is counting the cost index
the insured person insured at counted with a predefined combination of
groups, and
c) retaining a constant that is used to determine the boundaries of the
costs of the insured person, the exceeding of which are health
for the corresponding insured person covered by the funds in the
redistribution according to expensive paid services, and for the determination of the amount of the
resources from redistribution under expensive paid services that
health insurance for the insured person belongs.
(4) the Period is the calendar year.
section 20b
Adjustable parameters established implementing redistribution
Regulation in accordance with § AWACS (e). and) shall apply for the calculation of the calculated
the parameters of the redistribution.
§ 20 c
Health insurance company shall send to the Department of health until 31 December 2006. July
in the promotional information for the previous calendar year set
the implementing regulation issued pursuant to § AWACS (e). and the Ministry).
health care 15. September calculates and sends to the supervisory authority over the
the redistribution of resources from public health insurance (hereinafter referred to as
"The supervisory authority") and the health insurance calculated parameters
redistribution, which shall apply for the following period.
At the same time the Ministry of health shall forward to the supervisory authority and the
health insurance, on the basis of data have been calculated
parameters calculated, without putting the data on the nationality of the insured
the health insurance company. ".
6. section 21 and 21a, including headings:
"section 21
Monthly indices redistribution
(1) the health insurance fund shall communicate to the eighth day of the calendar
months of the special account manager
and the number of its policy holders in) each of the age groups and
oil and drug cartel-cost groups insured for these insurance companies to
the first day of the calendar month, including the number of insured persons with
the combination of these groups in cases where these combination subject
a valid correction for overlapping groups,
(b) the numbers of their policyholders insured) to the first day of this calendar
months in the case of those insurance undertakings, broken down according to law on public health
insurance, which is from the first day of the calendar month
the payer of the insurance State
(c) the amount of the premiums) for the preceding calendar month, and
(d) the number of insured persons referred to in points) a) and b), applicable to the first day
the calendar month preceding the month 3, the competent
redistribution.
(2) the information referred to in paragraph 1, inform the health insurance company in electronic
the form of a data message that is created in the electronic application, for
ensure a consistent form of the data disclosed health insurance companies
the special account administrator creates and updates the Ministry of
health care and health insurance for this purpose free of charge
provides.
(3) the Manager of the special account calculates the differences between the numbers of insured persons
submitted under paragraph 1. (d)) and the number of insured persons submitted
the insurance company in a calendar month on the 3 months preceding the
the redistribution. About the differences in the first sentence it modifies the administrator
the special account numbers of insured persons communicated by the relevant insurance company in
calendar month pursuant to paragraph 1. a) and (b)).
(4) the number of insured persons, for which the State pays the premiums, communicated to the
the relevant health insurance administrators of the special account referred to in
paragraph 1 (b). (b)) and adjusted in accordance with paragraph 3, are the basis for the
premium payment by the State. The Manager of the special account shall notify the total number of
insured persons pursuant to the first sentence, the Ministry of finance to the twelfth day
the calendar month.
(5) the administrator of the special account shall be notified by the 15th day of the calendar
months of each health insurance company the total amount that it accounts
of the redistribution by index. The total amount for the relevant health
the insurance company make up the insured's share of the standardised, multiplied by the
the number of insured persons the competent health insurance company standard.
(6) the number of standardized health insurance policyholders, the competent
is determined as the sum of the cost indexes of all of its policyholders.
(7) the insured person's share of the standard shall be determined by the amount of
intended for redistribution in a calendar month, less the total amount of
the monthly backups for such calendar month from redistribution under
costly covered services under section 21a, para. 4, divided by the total number of
standardized policy holders of all health insurance companies.
§ 21a
Redistribution according to expensive paid services
(1) the services covered by a Costly means paid services provided
to the insured, for which the level of remuneration appropriate health insurance for
one of the insured person exceeds the amount in the same period, reallocating
the sum of the income of the insured person's sickness insurance fund on this from
redistribution according to indexes and locking constants (hereinafter referred to as "costly
the insured person "). How to calculate income health insurance copayment
from redistribution according to indexes and locking constants defined in annex
No 2 to this Act.
(2) the health insurance fund shall be entitled to the payment of compensation for
expensive paid services, which are
a) 80% of the amount by which the cost of expensive paid services exceeds
the amount referred to in paragraph 1, but not more than an amount equal to four times the
locking constants, and
(b)) 95% of the amount by which the cost of expensive paid services exceeds
the sum of the six times the precautionary constants, and receive health insurance
the insured person of the redistribution by index.
(3) compensation for the costly paid service shall take the form of monthly
advance payments and annual accounts after the end of the
of the calendar year.
(4) the total volume of funds at the monthly advance payments
health insurance is provided for each calendar month
percentage of the amount designated for redistribution in this calendar
months ago. This share corresponds to the proportion of the total amount of compensation for
expensive paid services granted in the last financial year for which the closed
calendar year all health insurers and the total amounts for the
in the last financial year for which redistribution closed the calendar year.
(5) the competent health insurance company belongs to a monthly advance payment in
the amount of the percentage of the total volume of funds on
the monthly advance payments referred to in paragraph 4. This share corresponds to the proportion of
the total amount of compensation paid for the costly services of recognised
the relevant insurance company in the last financial year for which closed the calendar year and
the total amount of compensation paid for the costly services allocated in
the last financial year for which closed the calendar year for all insurance companies.
(6) the administrator of the special account shall be notified by the 15th day of the calendar
of the month to all health insurance the amount of monthly advances to them
It seems from the redistribution by costly covered services. ".
Footnote # 40 is deleted.
7. § 21a § 21b are inserted up to AWACS, which including the following titles:
"§ 21b
Monthly payments
(1) if the premium exceeds the selected the appropriate health insurance for
the preceding calendar month, the sum of the amounts on her fall from the
redistribution and reallocation of indices based on costly
covered services and that her manager of the special account referred to in paragraph 21 of the
paragraph. 5 and § 21a, para. 6, will pay the health insurance excess
the financial resources of the special account to the twenty-fifth day
the calendar month in which the amounts were reported. Health
an insurance undertaking which fails to comply with an obligation under the first sentence, the amount of
The Ministry of health a penalty of 0.1% of the amount due for
each calendar day following the due date to the date of payment
including. The finance charge is the income of the special account. The finance charge shall not health
the insurance company paid from the funds of the basic health insurance fund
or from the resources of the reserve fund.
(2) where the amount of the insurance selected the appropriate health insurance for
the preceding calendar month, the sum of the amounts on her fall from the
redistribution and reallocation of indices based on costly
covered services and that her manager of the special account referred to in paragraph 21 of the
paragraph. 5 and § 21a, para. 6, pointing out the health special account manager
the insurance undertaking of the missing funds within 15 working days from the date of
When health insurance company the following amounts announced. If the Administrator fails to comply with
the special account obligation under the first sentence, be established by the Ministry of
health care administrators special account a penalty of 0.1% of the outstanding
amount for each day after the due date to the date of payment, inclusive.
The finance charge is the intake of health insurance companies, against which a special administrator
the account has not fulfilled the obligation referred to in the first sentence. The finance charge shall not administrator
the special account paid from the funds of the special account, the basic Fund
health insurance or the resources of the reserve fund. By the phrase
the second reason is if he fails to fulfil its obligations by the administrator
the special account is the failure to fulfil obligations many health insurance companies
referred to in paragraph 1.
§ 21 c
Bill expensive paid services and joint follow-up group
(1) the health insurance fund of the special account manager in charge of the term
laid down for the submission of annual reports after the accounting closure
the calendar year all your costly insured for such year,
the total remuneration for each insured person, which includes the
compensation for medical services pumped abroad, and the amount of compensation for
expensive paid services under section 21a, para. 2. Health insurance
shall draw up a statement of their costly insured in electronic application
pursuant to § 21 para. 2. the administrator of the special account is entitled to the information referred to
in the first sentence should even on a different date, decides if the Supervisory
authority; in this case, health insurance companies are required to submit
information within 30 calendar days from the date of their request.
(2) To check the validity and the accuracy of the billing of costly
covered services are involved in all the health insurance companies. Administrator
the special account shall check via the joint supervisory
Group composed of doctors of all revision of health insurance companies. For
the purposes of this Act are doctors delegated individual audit trail
health insurance companies into the control group shall be entitled to inspect the
the Bill covered services submitted by any of the expensive medical
the insurance company. The special administrator account via a common control
the group is also to check the correctness of the classification of the insured to the
oil and drug cartel-cost groups.
(3) the health insurance fund is required to communicate to the Special Manager
account without undue delay cases in which on the basis of reduced
the provider reimbursement of covered services and the amount of costly this reduction.
The special account administrator performs this reduction within the framework of annual accounts
compensation for the costly-paid service.
(4) the administrator of the special account shall be calculated within 90 days from the date of receipt
statement of the overall amount to which individual health
insurance claim under section 21a, para. 2, and compares them with the total amount of them
provided by the advance payments. If the Administrator finds the special account
the difference between the claims and the amount of advance payments of more than 0.01% of the total
the amount of the advance payments, settles this difference in the following month, and
This, together with the amount of health insurance pursuant to section 21a, para. 6
also, notify the correct amount of this difference. About this repair
the amount is adjusted in the month concerned the resulting claim or obligation
health insurance companies according to § 21b and the amount of the claim or liability is
Adjusts the amount of redistribution in that month.
§ 21d
Supervision of the redistribution of
(1) compliance with the rules for redistribution and management with special
the supervisory organ shall supervise the account. Members of the supervisory body are
and) 1 representative appointed by the Ministry of finance,
(b)) 1 representative appointed by the Ministry of health,
c) 1 representative appointed by the Ministry of labour and Social Affairs,
(d)) 1 representative of general health insurance company of the United States
and
e) 1 representative from each of the other health insurance companies responsible for health
the insurance company, which in the supervisory board represents.
(2) the members of the supervisory body referred to in paragraph 1 (b). a) to (d)) have
every 1 vote. Members of the supervisory authority referred to in paragraph 1 (b). (e))
add up to 1 vote.
(3) the supervisory authority shall check the accuracy of the particulars supplied pursuant to
§ 21 para. 1. If a health insurance company during the inspection fails to provide
the necessary cooperation, shall report to the Supervisory Authority of the Ministry of health
the initiative to review the activities of the health laws
insurance companies. When you check in the first sentence shall not apply the provisions of
the inspection procedure on offences and administrative offences.
(4) the supervisory authority passes the Department of health inspection
reports of inspections carried out pursuant to paragraph 3.
(5) if the Ministry of health in controlling the errors in the data
communicated by the health insurance company pursuant to § 21 para. 1, as a result of
the amount was accounted for by the health insurance company pursuant to § 21 para. 5
calculated higher than it should be, it shall notify the administrators
the special account. The Manager of the special account, settlement of this difference in
the following month, so that the health insurance company together with the amount
under section 21a, para. 6 shall be notified whether or not the amount by which the relevant month edits
the resulting claim health insurance pursuant to § 21b, and on the amount
the special account manager adjusts the amount intended for redistribution.
section 21e
The administrative tort
(1) the health insurance fund is committing an administrative offense that by
inspection under section 21d paragraph. 3 the supervisory authority does not provide the necessary
synergy.
(2) for the administrative offence referred to in paragraph 1 shall be imposed to the 500 000 CZK.
(3) the health insurance fund for the administrative offence does not match, if the
demonstrates that he made every effort, that it was possible to require that
breach of legal obligations.
(4) in determining the amount of the fine to take account of health insurance
the severity of the administrative offense, in particular, to the manner of its perpetration, and his
consequences and the circumstances under which it was committed.
(5) the liability of the insurer for the administrative offence shall cease, if the
on the administrative authority has commenced proceedings within 1 year from the date on which it
learned, but not later than within 3 years from the date on which it was committed.
(6) an administrative offence in the first degree dealt with the Ministry of finance.
(7) income from fines provided for in paragraph 2 shall constitute revenue of the State budget.
§ AWACS
Powers of execution
The Ministry of health, together with the Ministry of finance Decree
provides for the
and 30.) April of the calendar year for the following period
redistribution
1. adjustable parameters and their values and redistribution
2. the requirements on the content, structure and format of the data for calculating the
the calculated parameters of redistribution,
(b)) the rules of procedure of the supervisory body,
(c)) the rules for the management of special account and
(d) the method of valuation) the cost of health services for the purposes of
redistribution. ".
8. In the heading of section 27, the words "record keeping" is replaced by "Central
the registry ".
9. In section 27 para. 1 the first sentence, the words "Central insurance company General
health insurance "are replaced by the words" general health insurance company "
and after the words "public health insurance" with the words "(hereinafter referred to
"the central register of insured persons") and manages it (hereinafter "administrator
the central register of insured persons ")", in the second sentence, the words "the register
in the first sentence shall be replaced by "central register of insured persons" and in the
the third sentence, the words "the register" shall be replaced by "leadership
the central register of insured persons "and the words" comprehensive health
insurance ' shall be deleted.
10. in section 27, paragraph 2 reads as follows:
"(2) the public authorities and legal persons that ex officio or
due to the subject of its activity shall keep a register of persons are obliged to
call the administrator of the central register of insured persons and within the time limits this
by the administrator to communicate to the Administrators provided for data needed for leadership
the central register of insured persons. This information is provided free of charge. ".
11. In section 27 para. 3 the words "health insurance company referred to in paragraph 1"
shall be replaced by "the administrator of the central register of insured persons".
12. in section 27, paragraph 3, the following paragraph 4 is added:
"(4) the administrator of the central register of insured persons provides information about
participation of the insured in the public health insurance system and the jurisdiction of the
of the insured person to the health insurance company health services providers. ".
The current paragraph 4 shall become paragraph 5.
13. in section 27 para. 5 after the word "leadership" is inserted after the word "Central", for
the words "leadership of the central register of insured persons" with the words "and for the
the management of the special account for the redistribution of "and the words" Central insurance company
General health insurance company in the Czech Republic shall "shall be replaced by
the words "administrator of the central register of insured persons shall be obliged to."
14. in section 27a para. 1 the words "Central insurance company General health
the insurance companies of the Czech Republic "shall be replaced by" the Central Manager
Register of insured persons "after the word" leadership "is added after the word" this "and
the words "public health insurance policy holders in accordance with § 27 para. 1 "
shall be deleted.
15. in section 27a para. 8, the words "the Central universal health insurance
the insurance companies of the Czech Republic "shall be replaced by" the Central Manager
Register of insured persons ".
16. under section 27a shall be inserted a new section 27b, which including the title reads as follows:
"§ 27b
Specific procedures to ensure the security and privacy of persons
(1) for the purposes of classification of the intelligence services, police of the Czech Republic and
General Inspectorate of security forces and ensure the safety of their
Members can use the specific procedures to ensure the confidentiality and
the safety of the activities referred to in section 1 of this Act.
(2) the special procedures provided for in paragraph 1 may be used
and) members
1. the intelligence services of the Czech Republic,
2. the police of the Czech Republic,
3. the General Inspectorate of security forces,
4. The fire brigade of the United States,
(b)), the intelligence service of the Czech Republic, police of the Czech Republic,
General Inspectorate of security forces and fire rescue Brigade of the Czech
Republic and the
c) bodies involved in the implementation of the public health insurance.
(3) the special procedures provided for in paragraph 1 shall be decided by the Government. ".
17. the annex is replaced by Annex 1, which including the title reads as follows:
"The annex No. 1 to Act No. 592/1992 Coll.
Age groups of insured persons for the redistribution of the premium indices
I------------------I------------------I------------------I------------------I
The number of groups and group number and age of: (I) age to:
I (men): I (women): I I I
I------------------I------------------I------------------I------------------I
And 1 to 20 and less than 1 year and less than 1 year and
I------------------I------------------I------------------I------------------I
2 and 21 and 1 year and 4 years and
I------------------I------------------I------------------I------------------I
And 3 and 22 5 years and 9 years
I------------------I------------------I------------------I------------------I
And 4 and 23 and 10 years of age and 14 years of age and
I------------------I------------------I------------------I------------------I
And 5 and 24 and 15 years and 19 years of age and
I------------------I------------------I------------------I------------------I
I 6 I 25 and 20 years and 24 years of age and
I------------------I------------------I------------------I------------------I
And 7 and 26 and 25 years and 29 years and
I------------------I------------------I------------------I------------------I
8 and 27 and 30 years and 34 years
I------------------I------------------I------------------I------------------I
I 9 I 28 and 35 years and 39 years
I------------------I------------------I------------------I------------------I
I 10 even 29 and 40 years and 44 years
I------------------I------------------I------------------I------------------I
And 11 30 and 45 years and 49 years
I------------------I------------------I------------------I------------------I
Even 12 and 31 and 50 years and 54 years
I------------------I------------------I------------------I------------------I
13 and 32 and 55 years of age and 59 years
I------------------I------------------I------------------I------------------I
I 14 and 33 and 60 years and 64 years
I------------------I------------------I------------------I------------------I
15 and 34 and 65 years and 69 years
I------------------I------------------I------------------I------------------I
Also 16, 35 and 70 years old and 74 years
I------------------I------------------I------------------I------------------I
I 17 and 36 and 75 years and 79 years
I------------------I------------------I------------------I------------------I
And even 18 37 and 80 years and 84 years
I------------------I------------------I------------------I------------------I
And 19 and 38 and 85 years and without limit, and
I------------------I------------------I------------------I------------------I
The key date for the inclusion of an insured person in the age group is the day
the achievement of a whole year of life, i.e., the birthday of the insured person. The insured person
the shifting to a higher age group always to date reached
the required age.
In groups 1 and 5 will be included from the date of birth of the beneficiary until the date of
preceding the day of his first birthday. Into groups of 2 and 21 will be
the insured person is included from the date of their first birthday, including up to date
preceding the date of his fifth birthday.
The other groups will be the insured person classified by analogy. ".
18. the following appendix 2, including the title reads as follows:
"Annex 2 to the law No. 592/1992 Coll.
Detailed design of redistribution
Part the first
Adjustable parameters of redistribution
Section And
A list of the oil and drug cartel-cost groups
1. A list of the oil and drug cartel-cost groups shall be drawn up in the format
table in which each row represents one-cost oil and drug cartel
the Group of. The columns of this table are in this order:
and pharmaceutical and cost) number-group
(b)) code-cost group, the oil and drug cartel
(c) the name of the oil and drug cartel)-cost group,
(d) of the definition list) anatomical therapeutic chemical groups of medicines
(hereinafter referred to as "the defining group of medicines") for the oil and drug cartel-the cost
Group on the appropriate line, or several of these lists, separated by
the words "and",
(e)) knockout rules with other pharmaceutical and-cost groups
prefaced with the words "no, if at the same time".
2. the oil and drug cartel-the cost group can the Ministry of health
include in the list of pharmaceutical and-cost groups, if they meet the
the condition of stability and a condition increase predictive power redistribution
in accordance with section E.
Section B
The list of age groups with the oil and drug cartel-cost group and
two of the oil and drug cartel-cost groups to each other
The combination of the groups can include the Ministry of health to
redistribution, if they meet the condition of stability and a condition increase
prediction of power redistribution in accordance with section E.
Section C
The coefficient for the calculation of the locking constants
The Ministry of health shall determine the value of the coefficient for calculating the
locking constants for each period of redistribution in the range of 70 to
250, so that the total projected amount of redistribution according to
expensive paid services in the relevant period amounted to redistribution
at least 5 and not more than 15 per cent of the total anticipated being redistributed as part
the amount in this period.
Section D
The boundaries of the consumption of drugs for inclusion of the insured person to
oil and drug cartel-the cost group
The Ministry of health provides the boundary value of consumption of medicinal products for
each period of redistribution in the range of 121-365, and taking into account the
the anticipated number of policyholders included in the
oil and drug cartel-cost groups and to the stability of the system
redistribution.
Section E
Rules for the classification of the oil and drug cartel-cost groups and combinations
groups into the system of redistribution
Verify the conditions for the inclusion of cost group system
redistribution is performed by the Ministry of health in the validation of the model
the system of redistribution, which coincides with the system of redistribution
under this law, and works with the latest available data
received Ministry of health from health insurance by
section 20 c (hereinafter referred to as "OMC").
Subsection And
The condition of stability
1. the condition of stability is for the oil and drug cartel-the cost group,
If
and) is included to the Group of at least 200 people and
(b) the total annual cost) people classified in the appropriate group exceeds
24000násobek average monthly cost based on the partition.
2. the condition for stability is the combination of two pharmaceutical and-cost
groups, if it is included in the relevant groups
at least 200 people.
3. the condition of stability is for the combination of the oil and drug cartel-the cost group
with age group, if it is in the appropriate combination of groups
enrolled at least 2500 people.
Subsection (B)
Condition prediction of power redistribution increases
1. for the oil and drug cartel-the cost group is a condition increase prediction
power redistribution, if appropriate
oil and drug cartel-the cost group at the same time subject to the following conditions:
and the strength of the authentication model Prediction), assembled without the inclusion of this
groups and combinations of groups, measured by the coefficient of determination R2 by
section M, at least compared with the verification 0.0001 model
built without a combination of groups, but with all the
oil and drug cartel-cost groups.
(b) the increment or decrement costs) responsible for this
oil and drug cartel-cost group, estimated in the validation of the model
drawn up without the inclusion of a combination of groups according to the procedure referred to in section M, is
statistically significant at the 1 percent level.
2. for the combined groups is a condition increase predictive power
redistribution is filled, if they are for the combined groups
at the same time subject to the following conditions:
and the strength of the authentication model Prediction) assembled without the inclusion of this
the combination of groups, measured coefficient of determination R2 according to section M,
falls at least 0.0002 compared with the validation model, in which
included are all the cost group, and all combinations of groups.
(b) the increment or decrement costs) responsible for this combination of groups,
estimated procedure according to section M, is statistically significant at level 1
the percentage.
Part two
Input data and classification policy holders for the purpose of calculating the calculated
the parameters of the redistribution
Section (F)
An overview of the data
1. In the calculation of the calculated parameters of redistribution are entering data
related to the last financial year for which there are calendar year that
The Ministry of health received from health insurance pursuant to section
20 c.
2. the Individual insured persons for the purposes of redistribution are characterised
a unique anonymous identifier number (hereinafter referred to as "anonymous
the identifier ") that gave them a central registry Manager allocates
policy holders. Anonymous identifiers are established as randomly
allotment and number sequence are allocated to the insured for the purpose of
protection of personal data of insured persons according to the law on the protection of personal data
and as a security measure under the law on cyber security.
Individual insured persons have been assigned to the following information:
and award-winning) the costs under section 20 (2). 7 (hereinafter referred to as "the cost").
(b)) number of months insurance (hereinafter referred to as "number of months"); the Moon is considered to be
per month insurance, if it was on the first day of this month the insured person
recorded one health insurance company as a participant in the public
health insurance (hereinafter referred to as "the Moon"). In the input
the data are only insured persons with at least 1 month of insurance.
The number of these people is also referred to as "the number of insured persons".
c) jurisdiction to age groups; jurisdiction of the insured person to age
groups shall be determined under the procedure referred to in section G.
(d) the nationality of the oil and drug cartel)-cost groups; the jurisdiction of the
of the insured person to the oil and drug cartel-cost groups shall be determined under the procedure referred
section H.
(e) a combination of membership groups); jurisdiction of the insured person to
a combination of the groups shall be determined pursuant to section I.
3. List of insured persons is called enumeration anonymous identifiers in the
ascending order, from lowest value to highest value.
Section G
Jurisdiction to age groups
The Ministry of health of the insured person to be classified on the basis of gender and year
and the month of birth to age groups according to the prevailing monthly
jurisdiction to the age groups in the last financial year for which the closed
calendar year; in the event that the insured person are given 2 age groups
the same number of monthly venue, Ministry of
the health of the insured person in the age group with higher definition age.
Monthly membership age groups are intended for this purpose
Depending on the age of the last day of the month. Count only
for months, the first day the insured person participant in the public
health insurance.
Section H
The jurisdiction of the oil and drug cartel-cost groups
1. the classification of the insured to the oil and drug cartel-cost group performs
The Ministry of health on the basis of information provided by individual
health insurance companies according to § 20 c and the list of medicinal products
which the State Institute for drug control (hereinafter referred to as "the Institute") decided on the amount of
and conditions of payment, and which is issued by the Institute under the law on public
health insurance (hereinafter referred to as "the list of drugs").
2. The Ministry of health of the insured person shall be placed in the
oil and drug cartel-the cost group if filled condition of consumption of medicines
for this group, and this group does not apply the knockout
rules with other pharmaceutical and-cost groups, for which the
the insured person filled condition of consumption of medicines. For insured persons, that
the consumption of drugs, he filled the condition is considered to be such an insured person, for which the
the sum of the usual daily therapeutic doses of pharmaceuticals relevant
the definition of the groups of medicinal products in each of the definition lists
the definition of the groups of medicinal products of the oil and drug cartel-the cost group border
drug consumption defined as configurable parameter for redistribution
the period of redistribution, for which parameters are calculated
redistribution is calculated. This total includes active
preparations is picked up or brought by the insured person in the last 12 months
his insurance, but for a period not exceeding the last two are finally closed
years of age.
Section I
Jurisdiction to the combination of groups
1. The Ministry of health of the insured person shall be placed in a combination of two
oil and drug cartel-cost groups, if it falls within either of these groups
and the appropriate combination of redistribution for the period for which they are
the calculated parameters of the model are calculated, established as the redistribution
adjustable parameter model of redistribution.
2. The Ministry of health of the insured person shall be included into the mix
oil and drug cartel-the cost group with age group, if it belongs to
both of these groups and the appropriate combination for the period of redistribution,
for which the calculated model parameters are computed, redistribution
established as the adjustable parameter of the model of redistribution.
Section J
Cost group
1. Cost groups are calculated for the purposes of the calculation of the parameters
designated age groups, pharmaceutical and-cost group and the combination of
groups.
2. the Cost of the group is for an individual insured person expressed in this
order:
and age group) in ascending order according to their numeric designations
referred to in annex 1 to this Act.
(b) the oil and drug cartel-the cost-group), sorted by the order referred to in
list of pharmaceutical and-cost groups as specified in section A; It shall apply
a list of the oil and drug cartel-cost group, which was established as a
adjustable parameter for the period of redistribution, for which they are
the calculated model parameters of redistribution are calculated.
(c)) the combination of groups listed in order of the list of combinations of groups
under section B; It is the list of groups, which was established
as the adjustable parameter for the period of redistribution, for which they are
the calculated model parameters of redistribution are calculated.
Part three
The calculation of the calculated parameters of redistribution
Section K
Mathematical objects necessary for the calculation of the calculated parameters
redistribution
Section L
Calculation of the locking constants
Section M
The calculation of cost indexes
Part four
Classification of insured persons for the purposes of the monthly indices redistribution
Section N
Classification of insured persons in the age group
For the purposes of the monthly health insurance their redistribution of the insured person
included in the age groups by sex and age for the achieved
the first day of the month in which redistribution takes place. List of age
groups and the definition of the achieved age are listed in Appendix 1 to this
the law.
The Section On
Classification of the oil and drug cartel-cost groups
1. for the purposes of the monthly indices are to be classified according to the insured's redistribution
the oil and drug cartel-cost group health insurance company, on the
the basis of the consumption of drugs of these insured persons and by list
oil and drug cartel-cost group and a list of drugs.
2. the insured person, which filled the condition of consumption of medicines needed for
inclusion in the oil and drug cartel-the cost group, is considered such a
the insured person, for which the sum of the usual daily therapeutic doses of medicines
relevant to the definition of the groups of medicinal products in each of the definition
lists the definition of the groups of medicinal products of the oil and drug cartel-the cost group
set the border of the consumption of drugs. This sum will be included
the drug, issued or delivered to the insured, with the date of the Bill in the last
12 months preceding the month for which the monthly redistribution
in progress. Health insurance the insured person shall be placed in the
oil and drug cartel-the cost group, if it is filled with the condition
consumption of drugs for inclusion in this group, and if this
oil and drug cartel-the cost group does not apply the knockout rules with
other pharmaceutical and-cost groups, for which the insured person
filled condition of consumption of medicines.
3. after the statement date shall be the date on which the relevant claim
insurance provider recognized and closed.
Section P
The combination of classification groups
1. The insured person is included in the combination of two pharmaceutical and-cost
groups, if it is included in both of these groups and the appropriate combination of
redistribution for the period defined as adjustable
parameter of the redistribution.
2. The insured person is included in the combination of the oil and drug cartel-the cost group with
age group, if it is included in both of these groups and the appropriate
the combination of redistribution for the period is calculated as
the adjustable parameter of the redistribution.
Part five
The cost index of the insured person and the insured person's income from redistribution
According to the indices
Section Q
The cost index of the insured person
The cost index of the insured shall be calculated as the sum of the numbers 1, cost
the index of the age group to which the policy holder is inserted, the cost indexes
all of the oil and drug cartel-the cost of the groups to which the policy holder is inserted
According to their consumption of drugs, and the correction for overlapping groups established for the
the relevant period of redistribution.
Section R
The insured's income from redistribution of indices
1. Receive health insurance on the insured person from redistribution under
indices are calculated for a specific period and for a specific redistribution
of the insured person.
2. Receive health insurance on the insured person from redistribution under
indices calculates as sum of monthly income on health insurance
This insured person from the redistribution of indices in the months of falling
in the corresponding period of redistribution, in which the insured person competent
This health insurance company.
3. the monthly income of the insured person's sickness insurance fund for redistribution
According to the indices calculates cost index as the product of an insured person for
the calendar month pursuant to section Q and a share in a standardised
the insured person is used in a calendar month pursuant to § 21 para.
7. ".
Article II
Transitional provisions
1. for the redistribution of premiums on health insurance premiums and
other income of the special account for public health insurance
selected 30. November 2017 applies Act No. 592/1992 Coll., in
the version in force before the date of entry into force of this Act.
2. for the annual accounts the remuneration paid for services especially costly
the year 2017 to 2018 it act 592/1992 Coll., in the version in force
before the date of entry into force of this Act.
3. for the purposes of the calculations related to the redistribution of health
the insurance company will appreciate the cost of health services for the year 2017 according to the law
No. 592/1992 Coll., in the version in force from the date of entry into force of this
the law.
4. for the reallocation taking place in the month of December 2017 shall apply
premiums health insurance companies in the period selected 18. up to 30. November
2017 and payment to the State for persons, for which the State pays the premiums,
that is credited to a special account in December 2017.
5. for the reallocation taking place in the month of January, 2018, the insurance applies
selected health insurance companies in the period 1. up to 31. December 2017 and
payment to the State for persons, for which the State pays the premiums, that is credited to the
special account in January 2018.
6. for the redistribution of premiums on health insurance premiums and
other income of the special account for public health insurance from 1.
until 31 January 2018. December 2018 shall apply Act No. 592/1992 Coll., in
the version in force from the date of entry into force of this Act, except that
Adjustable parameters for redistribution shall be determined as follows:
and a list of the oil and drug cartel)-cost groups
I-------I-----I-----------------------I------------------------------I--------------I
(I) the number and the name and Code of the definition list of anatomical and knockout even
I I I I therapeutic chemical and the rules and
I I I I I I pharmaceuticals groups
I-------I-----I-----------------------I------------------------------I--------------I
I 1 and GLA and Glaucoma and S01E I I
I-------I-----I-----------------------I------------------------------I--------------I
And 2 I THY even thyroid disorders and H03A, H03B I I
I-------I-----I-----------------------I------------------------------I--------------I
And 3 dogs and antipsychotic drugs, even outside (N05A N05AL03, I I
And even Alzheimer's disease, and N05AN01), N06DA, N06DX01., I I
I I I the treatment of addictions and N07BC51 I N07BB,
I-------I-----I-----------------------I------------------------------I--------------I
4 I also antidepressant and DEP N06A out (N06AA09, N06AX21) and no, if I
I I I I I at the DOGS and
I-------I-----I-----------------------I------------------------------I--------------I
(I) 5 and CHO and Hypercholesterolaemia and C1O out (C10AC01, C10BX03) and no, if I
I I I I I at DM1, and
I I I I I DM2, DMH And
I-------I-----I-----------------------I------------------------------I--------------I
6 and even Diabetes hypertension DMH and the A10 and C02 out I I
I I I I (C02KX, C02CA04), both in and outside of the C03
I I I I (C03CA01), and outside, C07 and C08
I I I I (C08CA06), C09 I I
I-------I-----I-----------------------I------------------------------I--------------I
And 7 and COP and severe asthma, R03AC18, R03AK03, R03BB I I
I I I I I I chronic obstructive
I I I I I I lung disease
I-------I-----I-----------------------I------------------------------I--------------I
I 8 I AST and Asthma and R03 outside (R03AC18, R03AK03, and no, if I
I I I I R03BB, R03CA02, R03BC01, and at the same time the COP I
I I I I R03CC02, R03CC13) I I
I-------I-----I-----------------------I------------------------------I--------------I
I 9 I DM2 and Diabetes type II and the A10 I no if I
I I I I I at DM1, and
I I I I I DMH I
I-------I-----I-----------------------I------------------------------I--------------I
10 and EPI and Epilepsy and N03 out (N03AX12, N03AX16, I I
I I I I I I N03AE01)
I-------I-----I-----------------------I------------------------------I--------------I
And 11 and CRO and Crohn's disease, I A07EA06, A07EC02 I I
I I I I I I ulcerative colitis
I-------I-----I-----------------------I------------------------------I--------------I
I 12 I also heart disease and KYS C01A, C01B, C01D, C01EB15, I I
I I I I C01EB17, C03CA01 I I
I-------I-----I-----------------------I------------------------------I--------------I
13 and TNF and rheumatic diseases and L04AA11, L04AA24, L04AB, I I
I I I treated with TNF inhibitors and L04AC I I
I-------I-----I-----------------------I------------------------------I--------------I
I 14 and REU and rheumatic diseases and A07EC01, L01BA01, L04AA13, and no, if I
I I I treated differently than I, L04AX03, M01CB01, M01CC01, and TNF-and at the same time
I I I the TNF inhibitors I P01BA02 I I
I-------I-----I-----------------------I------------------------------I--------------I
15 even PAR as well as Parkinson's disease and N04B I I
I-------I-----I-----------------------I------------------------------I--------------I
And 16 and DM1 and Diabetes type I I I no if A10A I
I I I I I I at DMH
I-------I-----I-----------------------I------------------------------I--------------I
I 17 I TRA I Lo4a A06 transplantation, L04AA10, L04AA18, I I
I I I I, L04AD01, L04AC02, And Even L04AD02
L04AX01 I I I I I I
I-------I-----I-----------------------I------------------------------I--------------I
I 18 I CFP even cystic fibrosis and also J01GB01, J01XB01, R05CB13 I I
I I I I I I the exocrine diseases
I I I I I I pankreasu function
I-------I-----I-----------------------I------------------------------I--------------I
And 19 and the CNS and brain disease and even, L03AB08, L03 Ab07 L03AX13, I I
I I I the spinal cord even L04AA23, M03BX01, M03BX02 I I
I-------I-----I-----------------------I------------------------------I--------------I
20 and even Malignancies and ONK L01 outside (L01BA01), L03AA, I I
I I I I I I L03AC01, L04AX04
I-------I-----I-----------------------I------------------------------I--------------I
And 21 and HIV and HIV, AIDS and J05AE, J05AF (J05AF08, even outside the I
I I I I J05AF10, J05AF11), J05AG, I I
I I I I J05AR, J05AX outside (J05AX05) I I
I-------I-----I-----------------------I------------------------------I--------------I
And 22 and REN and renal failure and B03X, Y03AE I I
I-------I-----I-----------------------I------------------------------I--------------I
And 23 RACES as well as the treatment of growth I H01AC01, H01AC03 I I
I I I I I I hormone
I-------I-----I-----------------------I------------------------------I--------------I
24 and mountains as well as Hormonal and L02 I I
I I I I I I oncological treatment
I-------I-----I-----------------------I------------------------------I--------------I
Even 25 and IPA I neuropathic pain as well as N01BX04, N03AX12, N03AX16 I I
I-------I-----I-----------------------I------------------------------I--------------I
(b)) the list of age groups with the oil and drug cartel-cost group
and two pharmaceutical and-cost group does not provide for each other.
(c) the coefficient for the calculation of the hedge), the constant has a value of 107.
(d) the consumption of drugs for Border) classification of the insured person to
oil and drug cartel-the cost group has a value of 181.
7. On the basis of the parameters referred to in point 6, the redistribution
the calculated parameters of redistribution for the period from 1. until 31 January 2018.
December 2018 shall be as follows:
Cost indexes) age groups and pharmaceutical and-cost groups
The cost indices of the age groups:
I------------------I------------------I------------------I------------------I
The number of groups as well as the cost and number of the Group and the cost and
I (men): (I) the index I (women): index I
I------------------I------------------I------------------I------------------I
I 1 I I 0.7926 I 0.6420 I 20
I------------------I------------------I------------------I------------------I
And 2 I-0.5097 and I-0.5659 and 21
I------------------I------------------I------------------I------------------I
And 3 I-0.5999 and I-0.6503 and 22
I------------------I------------------I------------------I------------------I
And 4 I-0.6160 and I-0.5818 and 23
I------------------I------------------I------------------I------------------I
5 I-24 and I-0.6427 0.5095 I
I------------------I------------------I------------------I------------------I
6 I-0.7183 and I-0.5422 and 25
I------------------I------------------I------------------I------------------I
7 I-0.7001 and I-0.4135 and 26
I------------------I------------------I------------------I------------------I
I 8 I-27 and I-0.6735 0.3590 I
I------------------I------------------I------------------I------------------I
I 9 I-0.6448 and I-0.4212 and 28
I------------------I------------------I------------------I------------------I
10 I-29 and I-0.6051 0.4667 I
I------------------I------------------I------------------I------------------I
I 11 I-0.5357 I-0.4090 I 30 I
I------------------I------------------I------------------I------------------I
I 12 I-0.4182 and I-0.3401 and 31
I------------------I------------------I------------------I------------------I
13 I-0.2469 and I-0.2886 and 32
I------------------I------------------I------------------I------------------I
14 I-0.0483 and I-0.2348 and 33
I------------------I------------------I------------------I------------------I
I 15 I 0.1832 I 0.0784 I I-34
I------------------I------------------I------------------I------------------I
And 16 and 0.4343 and 35 and 0.1191 and
I------------------I------------------I------------------I------------------I
I 17 I 0.5752 I I 0.2726 and 36
I------------------I------------------I------------------I------------------I
I 18 I 0.6427 I I 0.4432 and 37
I------------------I------------------I------------------I------------------I
And 19 and the 0.7943 and I 0.7461 and 38
I------------------I------------------I------------------I------------------I
The cost indices of the oil and drug cartel-cost groups:
I-----------------I-----------------I-----------------I
The number of Group I and group code Cost index I
I-----------------I-----------------I-----------------I
I 1 and GLA and 0.2246 and
I-----------------I-----------------I-----------------I
And 2 I I 0.2533 I THY
I-----------------I-----------------I-----------------I
And 3 dogs and 1.9603 and
I-----------------I-----------------I-----------------I
I 4 and I 0.8659 and DEP
I-----------------I-----------------I-----------------I
(I) 5 and CHO I 0.2838 I
I-----------------I-----------------I-----------------I
I 6 I I 1.0344 I DMH
I-----------------I-----------------I-----------------I
7 and COP and 1.8142 and
I-----------------I-----------------I-----------------I
I 8 I AST I 0.8682 I
I-----------------I-----------------I-----------------I
9 and also 0.4561 and DM2.
I-----------------I-----------------I-----------------I
10 and EPI I 1.3813 I
I-----------------I-----------------I-----------------I
11 and also 0.9823 and CRO
I-----------------I-----------------I-----------------I
12 and also 1.5601 and RVA
I-----------------I-----------------I-----------------I
13 and TNF and 14.4966 and
I-----------------I-----------------I-----------------I
14 and also 0.9963 and REU
I-----------------I-----------------I-----------------I
15 even PAR I 1.4167 I
I-----------------I-----------------I-----------------I
And 16 and I also 2.1692 DM1
I-----------------I-----------------I-----------------I
I 17 I TRA I 4.1426 I
I-----------------I-----------------I-----------------I
And even 18 CFP and 20.7391 and
I-----------------I-----------------I-----------------I
And 19 and the CNS and 10.1492 and
I-----------------I-----------------I-----------------I
20 and I 17.2183 and ONK
I-----------------I-----------------I-----------------I
And 21 and HIV I 10.7017 I
I-----------------I-----------------I-----------------I
And even the 22 and REN 41.6000 and
I-----------------I-----------------I-----------------I
I also 10.3981 23 RACES and
I-----------------I-----------------I-----------------I
24 and mountains as well as 2.2946 and
I-----------------I-----------------I-----------------I
Even 25 and IPA I 2.2671 I
I-----------------I-----------------I-----------------I
(b)) correction for overlapping groups.
(c) constant has a value of) locking 206 000 CZK.
8. the current members of the supervisory body pursuant to section 20 (2). 5 of law No.
592/1992 Coll., in the version in force before the date of entry into force of this
of the Act, are regarded as members of the supervisory body pursuant to section 21d paragraph. 1
Act No. 592/1992 Coll., in the version in force from the date of entry into force of
of this Act.
9. the present members of the joint follow-up group under section 21a, para. 11
Act No. 592/1992 Coll., in the version in force before the date of entry into force of
This Act shall be considered as members of the joint follow-up group under section
21 c of paragraph 1. 2 Act No. 592/1992 Coll., in the version in force from the date of acquisition
the effectiveness of this Act.
Article. (III)
Regulation (EEC)
Decree 644/2004 Coll., on rules with a special account management
comprehensive health insurance, the average cost of the rules
the order of the supervisory authority, is hereby repealed.
Article IV
The effectiveness of the
This Act shall take effect on 1 January 2000. January 1, 2018, with the exception of the provisions
article. I, points 8 to 16, which shall apply from the 15th day following its
its publication, and the provisions of article. II, points 1, 4 and 5, which will become effective
day of the 18. November 2017.
Hamáček in r.
Zeman in r.
Sobotka in r.