Rules Management Features. Account Všeob. Health Insurance

Original Language Title: pravidla hospodaření se zvl. účtem všeob. zdravotního pojištění

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Read the untranslated law here: https://portal.gov.cz/app/zakony/download?idBiblio=58635&nr=644~2F2004~20Sb.&ft=txt

644/2004 Sb.



The DECREE



of 13 June. December 2004



on the rules of management of the special account of the general health

insurance, the average cost and the rules of procedure of the supervisory authority



The Ministry of health, in agreement with the Ministry of Finance provides

under section 20 (2). 6 of Act No. 592/1992 Coll., on premiums for General

health insurance, as amended by law No 438/2004 Coll. (hereinafter referred to as

the "law"):



§ 1



The subject of the edit



This Decree regulates the rules of management of the special account

General health insurance details to claim

the payment of expensive care, the method of calculating the average cost of the insured person in

individual groups according to age and gender, the cost indexes

age groups including pricing and cost assignment to these groups

and the average cost per insured person in the system of General

health insurance and the rules of procedure of the supervisory authority.



§ 2



Introductory provisions



General health insurance Czech Republic ^ 1) (hereinafter referred to as

"The undertaking"), and departmental, industry, corporate, and other health

the insurance company ^ 2) (hereinafter referred to as "employment insurance") shall be communicated to the insurance undertaking,

which by law manages the special account (the "account manager"),

the data needed for the redistribution of the insurance premiums for general health

the insurance. These data shall be communicated in writing or by electronic means

using an advanced electronic signature based on a qualified

the certificate ^ 3) in the data interface of the specified administrator account.



§ 3



The average cost per insured person in the system of General

health insurance



(1) the insurance undertaking of the insurance undertaking and the employee shall provide to the administrator account in

deadline for the submission of annual reports, details of their

the annual total cost for health care expenses paid from the

public health insurance to the extent and under the conditions laid down

a special law ^ 4) (hereinafter referred to as "paid to care"), vyúčtovanou and

recognised in a given calendar year and granted on the territory of the Czech Republic

and the number of its policyholders to 31. December of the calendar

of the year.



(2) an insurance undertaking shall calculate and account manager, employment insurance

referred to in paragraph 1, the average cost per insured person in the system

universal health insurance and shall communicate them to the 35 days from the granting of

These data, and employment insurance.



§ 4



Cost indexes, age groups and valuation and assignment of costs



(1) the insurance undertaking of the insurance undertaking and the employee shall provide to the administrator account for the

the previous calendar year and the deadline for the submission of their

the annual reports by the Ministry of health to the Ministry of

finance policy holders and the total annual cost to the policyholder in

individual groups according to age and gender. These costs shall be deducted from the

part of the cost of expensive insured under section 21a, paragraph. 3 of the Act and article. (VI)

Law No 438/2004 Coll., amending Act No. 551/1991 Coll., on the

General health insurance company in the Czech Republic, as amended

legislation, law No. 280/1992 Coll., on departmental, industry, corporate, and

other health insurance companies, as amended, the law

No. 592/1992 Coll., on premiums for general health insurance, as amended by

amended, and Act No. 48/1997 Coll., on public health

insurance and amending and supplementing certain related laws, as amended by

amended, (hereinafter "Law No 438/2004 Sb.).



(2) for the determination of the number of insured persons in each group according to age

and sex, and the total annual cost of insured persons in each

groups according to the age and sex of the undertaking and the employee insurance



and) apply



1. the number of insured persons in each group by age and sex to the 1.

day of the month,



2. the average number of insured persons in each group according to the age and

sex for the last financial year for which closed the calendar year calculated as the proportion of

the sum of the number of insured persons in each group by age and sex to the 1.

the date of all the months of the calendar year and the number 12,



(b) health care) to the insured person, so that the



1. the total annual costs of the insured person shall all

the cost of health care provided to the insured persons whose remuneration

It is set in the canopy and in the tops of the award-winning volume reported

the points that have been reported with the billing of medical devices for

the calendar year and the insurance undertaking or the employment insurance

recognised,



2. the total annual health care costs not counted impacts

legal and contractual or regulatory mechanisms and bonifikačních

any increase in total payments arising from the annual increase in the selection

insurance premiums,



(c)) shall apply for the award



1. paid care declared and recognized in the points price point, which was for

the Group of medical facilities and for the period published in the

Journal of the Department of health as a result of the agreement in accordance with

special legal regulation ^ 5) (hereinafter referred to as the "conciliation procedure"), or

established under special legislation. ^ 6) in the case where the

one group of medical facilities and price point according to the period of the sentence

the first has not been published, it shall apply for the appraisal of the last published

the price point for this group of medical facilities. If it was for the

a group of medical devices published or fixed price

as a minimum, shall be used for the valuation of this price. If it has been

published or laid down for part of the Group of medical device

different price point, this Part applies to medical devices

This price point,



2. payment for the number of registered insured practical doctors a valid

the minimum amount of the payments for the period agreed in the conciliation

management,



(d) the costs referred to in point (a)) (b)) awarded under (c)) to

each of the groups by age and sex, and by the age of the insured person

reached to 1. day of the calendar month in which it was paid to the care

granted.



(3) for the determination of the expensive policy holders and the deduction of costs paid

Insurance and employment insurance under section 21a, paragraph. 3 of the Act, and

article. (VI) point 1 of law No 438/2004 Coll., the total amount is crucial

the costs associated and award referred to in paragraph 2, that have been

medical devices reported with billing for the calendar year

and the insurance company or employment insurance. In the event that the

costly beneficiary ^ 7) during the calendar year belongs to two groups

by age and sex, the insurance company and the employee insurance

part of the cost of expensive insured under section 21a, paragraph. 3 of the Act and article.

(VI) point 1 of law No 438/2004 Coll., shall be deducted from the cost of the group according to the

age and gender, to which the relevant month costly beneficiary belongs.



(4) account manager calculates to 35 days from the provision of data by the insurance company and

employment insurance undertakings referred to in paragraph 1 the cost indexes

individual groups according to age and sex, and communicated to the Ministry of

health care.



§ 5



A claim for the payment of expensive policy holders



The insurance company and employee insurance charge all of your account manager

costly insured for the calendar year under section 21a, paragraph. 3 and

10 of the Act. Part of the Bill is an insurance company and staff

insurance companies claimed the amount of expensive care. Annex No 1 is

specified data interface for the transmission of the statement of costly

insured persons and employers ' insurance companies.



§ 6



Rules management special account



(1) on the basis of a written communication from the insurance company and employee

insurance companies of improperly reported the number of insured persons, which is the payer

the insurance State Manager performs the account when the next notification

The Ministry of finance in accordance with section 27. 3 of these data for the repair

the whole of the period for which they have been incorrectly reported.



(2) if the written communication referred to in paragraph 1 shows that the



and the number of insured persons was notified) less than their actual observed

the number of State insurance, pays the assessment base set

special legal regulation under section 3 c of the Act, and for the number of

insured persons, which is the difference between the actual and the notified

the number of. This supplement shall be carried out simultaneously with the next monthly payment

for persons, for which the State is liable to pay the premiums. The balance shall be redistributed

at the same time with a monthly payment that was paid. When this

redistribution is Undertaking and occupational insurance at the same time

added the difference between improperly notified and corrected the number of insured persons,

for which the State is liable to pay the premiums, and that for the whole of the period for which they were

These data incorrectly reported,



(b) the number of policyholders has been notified) are larger than their actual observed

the number of the account manager shall notify the Ministry of Finance of overpayment on the insurance.

The excess on the insurance is borne by the State cleared the insurance when

the next monthly payment, pursuant to section 12 of the Act. This redistribution is
The insurance company and the occupational insurance at the same time subtracted the difference between

incorrectly notified and corrected the number of insured persons, which is the payer

the insurance State, for the entire period for which these data have been

incorrectly reported.



(3) on the basis of a written communication from the insurance company and staff

insurance companies of improperly reported the number of insured persons in each

groups by age and sex the next time an administrator account

the redistribution prior to the calculation of the total amount of repair by adding or

by subtracting the difference between improperly notified and the actual number of

insured persons by age groups.



(4) If the insurance undertaking of the insurance undertaking shall inform the employee of incorrectly

the selected insurance, an account manager at the nearest

the redistribution prior to the calculation of the total amount of repair by adding or

by subtracting the difference between the amount of the premium sdělenou incorrectly selected and

the amount of the premium actually observed the selected.



(5) prior to the determination of the share of the insured person in accordance with section 21 of the standardised

paragraph. 3 of the Act shall be deducted from the account manager monthly premiums paid

State funding in the amount of the total financial

resources on the monthly advance payments.



(6) prior to the determination of the share of the insured person in a standardized month in

which carries out annual bill advance payments on expensive care,

cleared the account manager with monthly premiums borne by the State financial

resources in the amount of the difference between the claims of the insurance undertaking and the employee

insurance companies and the amount of the advance payments for costly policyholders.



(7) the financial resources belonging to the insurance undertaking and occupational

undertakings pursuant to section 21a, paragraph. 9 law converts the account manager in two

parts. The first part of the payments from the funds of insurance shall provide

to be borne by the State, and it immediately after the announcement of the results of the redistribution provided for in

§ 21a paragraph. 7 of the Act. The second part of the payment shall, after receipt of payment

special account from the insurance company and employee for insurance under section 21a

paragraph. 8 of the Act, to a maximum of ten working days from the first part of the

payments under section 21a, paragraph. 9 of the Act.



(8) the administrator account rounds the calculated total amount attributable to the

The insurance undertaking of the insurance undertaking and the employee after the redistribution on the whole of the Crown

down. This applies mutatis mutandis to the calculated total amount of monthly advance

payments and the total amount of costly care to which they are Undertaking and

employment insurance claim for the last financial year for which the enclosed calendar

year, and the average cost per insured person in the system of General

health insurance.



(9) the administrator of the account rounded to the nearest cost indexes to four decimal

space.



section 7 of the



The rules of procedure of the supervisory authority



(1) the members of the supervisory body appointed by the membership of the credentials or

the supervisory authority referred to in section 20 (2). 5 of the Act shall transmit a certified copy of the

his appointment or credentials to the membership of the Supervisory Board, administrators

account.



(2) the members of the supervisory organ shall elect a Chairman from among their ranks, Vice-Chairman

and the Manager for a period of one year. When you select this option, each Member of the

the supervisory authority of the one voice that employee representatives

insurance companies have put together one vote. ^ 8) the Chairman, Vice-Chairman and

the Manager can choose. Vice-Chairman of the supervisory authority

representing the President in his absence throughout the range of its

the scope of the. Managing Director of the supervisory authority shall perform the duties imposed on him by the supervisory

authority in relation to the organizational requirements of the activities

the supervisory authority.



(3) the supervisory authority shall be convened by the Chairman of the supervisory authority

Once a month. If necessary, convene the extraordinary meeting

the Chairman, Vice-Chairman or account manager. At a time when it is not selected

the Chairman or Vice-Chairman of the supervisory authority, shall convene the meetings of the supervisory

authority of the administrator account.



(4) the meetings of the supervisory authority is the public. On a proposal from a member of the supervisory

authority of the Chairman of the supervisory body of the invite to meetings of other persons,

necessary to discuss issues related to the supervision of compliance with the

the rules of management of the special account.



(5) a representative of the administrator of the account shall inform the supervisory authority of each of the negotiations on the

the management of the special account, it passes all members of data transmitted

Insurance and employment insurance in accordance with this Ordinance,

the results of carried out monthly, annually, the data redistribution

annual accounts and the amounts claimed by the costly insured for these

the insured person.



(6) the supervisory authority in its negotiations in writing instructs its members to

check the data of the insurance undertaking and the employee insurance undertakings that are

monthly basis for the redistribution of the insurance premiums.



(7) on the progress of the negotiations is made by the Managing Director of enrollment, that way the administrator

the account shall be sent to all members of the supervisory body. Any objections to the content

the registration shall be dealt with at the next meeting of the supervisory organ. The registration must

always include the date of the negotiations, a list of the members present and a brief table of contents

the negotiations on specific discussion points with the adopted conclusions.



(8) before the commencement of the hearing, the participants may agree on the acquisition

an audio recording of the representative of the account manager. The acquisition of the record vote

in a way, referred to in paragraph 9 with the fact that when you tie the sound

record nepořizuje. The record is passed to the store administrator account until the

before the supervisory authority shall decide on the liquidation of its komisionální.



(9) the decision of the supervisory authority can receive only in case when the

present members of the supervisory authority have at least 3 voices. About adoption

the decision shall be voted on publicly. The supervisory authority shall take its decision

a majority of the votes. The Chairman shall convene at the equality of the votes of the supervisory authority

by the end of the following week the new negotiations of the supervisory authority.

The voice of the employee insurance for or against the decision of the supervisory

the authority is determined separately from the outcome of the voting members present,

the representatives of the workers ' insurance; in the case of equality of votes, the

the vote is repeated, and then considers this voice behind injunctions

the vote.



§ 8



Common provisions



(1) for determining advances expensive care and costly insured per year

2003, shall apply the amount of 354 900 Czk, which is 30 times what

the average cost of one insured persons in the system of General

health insurance in 2001.



(2) for the determination of the advances of the costly care and costly insured per year

2004 shall apply the amount in the amount of Czk 396 090, which is 30 times what

the average cost of one insured persons in the system of General

health insurance in 2002.



(3) for the determination of the advances of the costly care and expensive client in

2005 shall apply the amount of 420 900 CZK, which is 30 times what

the average cost of one insured persons in the system of General

health insurance in 2003.



(4) the cost indexes for redistribution in 2005 are listed in the

Annex No 2.



(5) in 2005, provides for the total volume of financial account manager

resources on the monthly advance payments and employment

insurance companies and the amount of the advance payment to the insurance undertaking and occupational

undertakings pursuant to section 21a, paragraph. 5 and 6 of the Act on the basis of data

provided by the insurance company and employment insurance for the year 2003.



(6) in the year 2006 the total volume of financial account manager

resources on the monthly advance payments and employment

insurance in the amount of the advance payments to the insurance company and the occupational

undertakings pursuant to section 21a, paragraph. 10 of the law, the insurance company and employee

the insurance company shall provide the following information in the data interface specified in annex

No 1.



(7) in 2005, in which the portion of the premium referred to in article redistributes (VI)

points 2, 3 and 5 of law No 438/2004 Coll., the account manager in the overall

the amount, which belongs to the insurance company and the occupational insurance after

redistribution and which is compared with a selection of premium under section 21a

paragraph. 8 and 9 of the law, resources in the amount of 40% of 65% of the selected

insurance, that insurance undertaking and occupational insurance companies remain

According to the article. Vi, section 3 of the law No 438/2004 Sb.



(8) in 2006, in which some of the premium referred to in article redistributes (VI)

points 2, 4 and 5 of law No 438/2004 Coll., the account manager in the overall

the amount, which is the responsibility of the insurance undertaking and occupational insurance after

redistribution and which is compared with a selection of premium under section 21a

paragraph. 8 and 9 of the law, resources in the amount of 40% of 30% of the selected

insurance, that insurance undertaking and occupational insurance companies remain

According to the article. Vi, section 4 of the law No 438/2004 Sb.



§ 9



Cancellation provisions



Repealed the Decree 305/1996 Coll., on rules of management

special account of the general health insurance system and the rules of procedure

the supervisory authority.



§ 10



The effectiveness of the



This Decree shall take effect on 1 January 2005. January 1, 2005.



Secretary:



doc. MUDr. Emmerova, CSc., in r.



Annex 1



Data interface Bill costly policyholders



1. Health insurance companies shall carry out annual freight bill of health
care under section 21a, paragraph. 10 of the Act, for which the health insurance company

entitlement to payment of 80% of the amount by which the costly care exceeds the amount

under section 21a, paragraph. 2 in this Act, the data interface:

the code for health insurance:



------



------



year:



------



------



Section i: section II (in CZK): section III (in CZK):



the order of the costly annual remuneration for the cost amount at stake napojištěnce

policyholder insured pursuant to section 21a, paragraph. 2 under section 21a, paragraph. 3 of the law

law



------------------ ------------------------------- --------------------------------

00 00 00 00 1

------------------ ------------------------------- --------------------------------

00 00 00 00 2

------------------ ------------------------------- --------------------------------

00 00 00 00 3

------------------ ------------------------------- --------------------------------

00 00 00 00 4

------------------ ------------------------------- --------------------------------



------------------ ------------------------------- --------------------------------



------------------ ------------------------------- --------------------------------



------------------ ------------------------------- --------------------------------

x x x x x

------------------ ------------------------------- --------------------------------



The total amount of

for a health insurance company

in CZK:

------------------------------- --------------------------------



------------------------------- --------------------------------



2. the part of the data interface is the acquisition date and signature of the authorized

person and stamp of the competent health insurance company.



Annex 2



Cost indexes for redistribution in 2005

-----------------------------------------------------------

Age group of cost indexes 18 age groups

policy holders

broken down by sex

-----------------------------------------------------------

from the men women

-----------------------------------------------------------

0 5 1.5247 1.3161

-----------------------------------------------------------

5 10 0.9301 0.8124

-----------------------------------------------------------

10 15 0.8556 0.8390

-----------------------------------------------------------

15 20 0.7937 1.0000

-----------------------------------------------------------

20 25 0.7121 1.0844

-----------------------------------------------------------

25 30 0.7555 1.3844

-----------------------------------------------------------

30 35 0.8439 1.4002

-----------------------------------------------------------

35 40 0.9632 1.3554

-----------------------------------------------------------

40 45 1.1712 1.4990

-----------------------------------------------------------

45 50 1.5319 1.8846

-----------------------------------------------------------

50 55 2.1162 2.3109

-----------------------------------------------------------

55 60 2.8569 2.6241

-----------------------------------------------------------

60 65 3.4519 3.0564

-----------------------------------------------------------

65 70 4.2894 3.6547

-----------------------------------------------------------

70 75 5.1215 4.3501

-----------------------------------------------------------

75 80 5.6613 4.8750

-----------------------------------------------------------

80 85 5.8683 5.3291

-----------------------------------------------------------

85 and more 4.4390 5.4401

-----------------------------------------------------------



1) Act No. 551/1991 Coll., on the Czech General health insurance company

Republic, as amended.



2) Law No. 280/1992 Coll., on departmental, industry, corporate, and

other health insurance companies, as amended.



3) Act No 227/2000 Coll., on electronic signature, as amended

regulations.



4) Act No. 48/1997 Coll., on public health insurance and amending and

addition of related laws, as amended.



section 17, paragraph 5). 5 of Act No. 48/1997 Coll., as amended.



6) Article. (II) Act No. 459/2000 Coll., amending Act No. 48/1997 Coll.,

about the public health insurance and amending and supplementing certain

related laws, as amended.



Regulation of the Government No. 458/2000 Coll., laying down the values of point and above

reimbursement of health care paid for by public health insurance for 1.

half of 2001.



Decree No 532/2002 Coll., laying down the remuneration of health care from

public health insurance, including regulatory restrictions for 1.

half of 2003.



§ 21a, paragraph 7). 2 Act No. 592/1992 Coll., as amended by law No 438/2004

SB.



8) section 20 (2). 5 of Act No. 592/1992 Coll., as amended.