Medical insurance – types, advantages, disadvantages, formalities and price

Medical insurance in Poland may be public, but also private. Public health insurance applies to every working citizen and every person from the group of pupils, students, pensioners or the unemployed. Public medical insurance guarantees us access to public health care financed by the National Health Fund. Is this form of medical insurance sufficient? Is it worth choosing additional medical insurance and when? What formalities are related to the purchase of insurance and how much can it cost? What are the pros and cons of public and private medical insurance?

What is medical insurance?

Medical insurance in Poland is a compulsory service and at the same time offers services that are available to all citizens. Every working Pole is obliged to pay monthly medical insurance contributions. In the case of a full-time job, the contributions are partly based on the salary and partly covered by the employer. Thanks to these contributions, working citizens are insured and can benefit from a wide range of medical benefits financed from the public fund.

Public medical insurance, i.e. this compulsory benefit, is the first type of insurance that allows us to protect our health.

The second type of medical insurance is voluntary insurance, in which the patient himself decides about the payment of premiums. Voluntary medical insurance it usually applies to people who work on a contract of work, are freelancers and their salary is not necessarily burdened with a health insurance contribution.

The third possible type of insurance in Poland is private medical insurancewhich is usually treated as a supplement to the compulsory health insurance contribution. Private medical insurance is offered by insurance companies and usually includes packages of additional services with higher quality and faster access.

From a legal point of view compulsory medical insurance in Poland was introduced by the repealed Act on universal health insurance of February 6, 1997. This system covers the majority of Poles. According to the regulations, the obligation to pay health insurance contributions applies to employees.

On the other hand, the Act of 27 August 2004 on health care services financed from public funds defined persons covered by general insurance, as well as the conditions and scope of healthcare services.

This type of medical insurance is intended for employees and contractors as well as for business people. It should also be remembered that children, pupils, students, retirees, pensioners and the unemployed are entitled to healthcare services.

Public medical insurance is activated as soon as a patient enters it. And registration for health insurance is the responsibility of the party who pays the premium, usually the employer. The school and the university are respectively responsible for the health insurance of pupils and students. However, in the case of the unemployed, this obligation rests with the employment office. People running a business independently apply for insurance and pay the indicated rate every month.

Public health insurance is charged on each employee’s salary, and the rate charged is 9% of the basis of assessment. In the case of entrepreneurs, the basis for determining the health insurance premium is the declared amount, not lower, however, than 75% of the average monthly salary in the enterprise sector in the fourth quarter of the previous year, including payments from profit announced by the President of the Central Statistical Office.

In 2019, the health insurance premium for entrepreneurs was PLN 342. However, the premium for the months of April, May and June 32 is not less than PLN 2021 per month.

The entity responsible for public health care in Poland is the National Health Fund (NFZ) established in 2003.

What medical insurance can you take advantage of in Poland? Check: Compulsory, voluntary and private health insurance – what do you need to know about them?

Private medical insurance – characteristics

Private medical insurance is a type of insurance that an increasing number of Poles choose. It is a fact that the number of Poles who choose additional private medical insurance is constantly growing. According to the estimates of the Polish Insurance Association, in the first half of 2020, such insurance was already used by over 3 million Poles, i.e. by 13,1 percent. more than in 2019.

What exactly is private medical insurance? Private medical insurance is an additional and voluntarily purchased service, thanks to which the patient can gain access to tests, treatments, visits to specialists or other medical services, usually of higher quality, without long waiting in the queue.

Private medical insurance is voluntary and allows patients to have faster access to tests, treatments or visits and consultations with a wide range of specialists. Having private medical insurance significantly reduces the waiting time in line for a specific medical service.

Private medical insurance is usually purchased with an insurance company of your choice. This choice can also be made by the employer if the company we work for wants to offer this type of benefit for his team.

The insurance company determines, first of all, the monthly rates and the scope of services to which the patient will have access. On this basis, a contract is signed, which is usually concluded for a period of one year. The contract is automatically continued unless terminated in writing by the customer 30 days before the end. It is also possible to change the terms of the contract. You only need to inform the insurer 30 to 45 days in advance of each policy anniversary.

It happens that insurance companies introduce the so-called insurance grace period access to some, usually more expensive or luxurious services. The insurance grace period is a period in which the patient cannot take advantage of the insurance, even if he pays the premiums. The insurer may indicate that the grace period covers such services as rehabilitation, aesthetic medicine treatments or care for a pregnant woman. Therefore, it is very important to read the GTC before signing the contract, i.e. General Terms and Conditions of Insurance.

Private health insurance is available to patients in two main variants:

1. health policy – offered by insurance companies;
2. medical subscription – offered by private healthcare institutions.

Private health insurance can also be divided into:

1. individual insurance – purchased independently by the patient;
2. group insurance – bought out by employers.

It is very important not to confuse private medical insurance with voluntary medical insurance within the meaning of the Act of 27 August 2004 on health care services financed from public funds. This voluntary medical insurance concerns insurance in the National Health Fund and is recommended primarily to those who do not have permanent employment and their work is conditional on a contract for specific work.

What are medical subscriptions and when should you decide on them? Check: Medical subscriptions – how much does it cost and when does it pay off?

Types of private medical insurance

Private medical insurance can cover various health care services. Based on the guaranteed health services, the following types of private medical insurance can be distinguished:

1. outpatient insurance – it is a type of private medical insurance that is most often offered by insurance companies. The scope of services in outpatient insurance includes consultations with doctors and specialists, a wide range of diagnostic tests, individual medical procedures, including those that do not require hospital treatment. In the case of outpatient insurance, the patient can usually use the services of several dozen, often several hundred, medical facilities throughout Poland. This number depends on the selected insurance company. Having outpatient insurance in a given medical facility, it is usually enough to only show the insurance card, which entitles you to take advantage of specialist advice, diagnostic tests and other services available in the offer without cash. However, it should be remembered that outpatient insurance does not cover the patient’s stay and treatment in the hospital. Although some insurance companies also offer hospital insurance;
2. hospital insurance – as already mentioned, insurance companies also offer their clients hospital insurance, which may differ in the scope of benefits. The most important advantage of this insurance is easy and quick access to hospital treatment in good conditions. Hospital insurance may cover from around 70 to 250 procedures and services for which there are very long queues in the public system. Hospital insurance may, on the one hand, cover the organization and coverage of the costs of operations and treatments, and, on the other hand, guarantee better conditions for hospitalization. Purchasing hospital insurance shortens the waiting time for a procedure or surgery even to several days. For comparison, you have to wait several months, sometimes even years, for the same procedure from the public pool of funds. Hospital insurance guarantees the patient quick access to the best specialists, individual nursing care, as well as hospitalization in comfortable conditions;
3. medical assistance – it is an additional service that perfectly complements hospital and outpatient insurance. Thanks to this service, the patient can take advantage of the XNUMX/XNUMX internet or telephone support provided by consultants of the insurance company. The consultants’ task is to identify the patient’s problem, offer help and arrange a visit to the patient’s current location. Medical assistance also includes medical assistance during patient transport, help in running the house after returning from hospital, and looking after children in the event of hospitalization. However, it is important to remember that medical assistance does not cover the costs of medical services;
4. drug insurance – it is one of the newest types of medical insurance in Poland. Currently, only a few insurance companies offer drug insurance. Having this insurance in an easy and effective way reduces the patient’s expenses on needed medications. Thanks to the drug insurance, the patient can buy prescription drugs at a reduced price. This type of insurance can reduce the cost of purchasing drugs by up to 80%. Drug insurance covers only drugs available in Poland for which the patient has a prescription. The list of these preparations is very wide and some insurance policies contain most or all of the drugs in their offer. Drug insurance is valid in selected pharmacies throughout the country, but insurance companies ensure that the list of pharmacies is extensive and constantly expanding. 

How much does health care cost us? Read: The Pole is not expected to see a doctor

Medical insurance – advantages

Private medical insurance is an additional service that can bring many benefits to the patient.

The advantage of private medical insurance there is quick and efficient access to a large number of specialists. It is also a guarantee of access to tests, not only the basic ones, but also to expensive and hard-to-reach diagnostics, such as magnetic resonance imaging or computed tomography. The added value of this access is the lack of visit limits, avoiding long queues and no need to have a referral for each visit or examination.

The advantages of private medical insurance also include the quality and comfort of the healthcare offered. Patients who only use the public health service often complain about the condition of Polish hospitals, the quality of service in registration or the level of services offered and performed. Private medical insurance is a guarantee of high-quality and professional approach to the client. Having private medical insurance, you can count on greater attention of the staff, individual approach to the problem or devoting time to a thorough medical interview and a quiet conversation with the patient.

In the case of private medical insurance, it is worth paying attention to quick access to specialists. The public health care system requires the GP to diagnose the patient and refer them to a specialist. The primary care physician will not always write out such a referral, and even if so, the waiting time for the next appointment can be very long, amounting to several months, and sometimes even a year. It very often happens that patients who have received a referral to a specialist ultimately choose a private visit to a specialist’s office anyway. Thanks to this, they avoid many months of waiting for a consultation.

The advantage of private medical insurance is that its possession does not affect the functioning of compulsory insurance in the National Health Fund. Thanks to this, the patient can use private and public health services at the same time.

How does teleporting with a GP work? Check: Free teleportation of a family doctor at the National Health Fund. Check how it works

Medical insurance – disadvantages

Despite the numerous advantages of private medical insurance, it is worth noting the disadvantages of this supplementary health policy. Among disadvantages of private medical insurance please indicate:

1. additional charge for insurance costs – the purchase of additional insurance is another expense that is charged to our account. The more services included in the package, the higher the price of such insurance. It should be remembered that the compulsory insurance cannot be canceled, so the patient is obliged to pay a double premium every month;
2. a limited set of medical services – private medical insurance does not cover healthcare in every reported case. We can only ask for help in certain disease situations covered by the signed contract;
3. limited scope of the insurer’s liability – the contract we sign with the insurance company often specifies a list of circumstances that may result in refusal to provide the service. If you go to your health care provider for an illness that is the result of drug or alcohol poisoning, a suicide attempt, an officially declared epidemic, or criminal activity, your health care provider may decline to provide you with medical assistance. 

Teleportation or a visit to the doctor’s office? Check: When is teleportation enough and when to go to an appointment? Expert Council

Medical insurance – formalities

Before the patient decides to sign a contract with an insurance company, it is worth looking at several criteria that will help you choose the best possible private medical insurance offer. Before completing the formalities, it is worth taking a look at the following aspects:

1. the scope of medical services guaranteed by the insurer – the contract we sign should contain the number and type of medical consultations that are available under private health insurance. It is also worth paying attention to the list of tests that are part of the package;
2. access to specific specialists – the contract should contain a list of specialists to whom the patient will have free access. They are usually internists, paediatricians or gynecologists. If a patient wants an endocrinologist or a gastroenterologist on this list, the cost of insurance will increase;
3. additional medical services – some patients want more services that they will have access to. In this case, it is worth including such information in the contract;
4. insurance grace period for specific services – some medical services under private health insurance are subject to a grace period. This mainly applies to the most expensive services, such as, for example, dental care;
5. waiting time for the visit – it is necessary to compare in offers what is the waiting time for specific specialists;
6. number and location of medical facilities – check which medical facilities cooperate with the insurer and whether it will be possible to use their services in the most comfortable way for the patient;
7. quality of customer service – how patients can make an appointment, e.g. via an app or by phone;
8. individual needs of the patient – health insurance should be adjusted to the patient’s health condition, age and lifestyle and work.

After analyzing the offers in terms of the above-mentioned criteria, you can proceed to arranging the formalities. Depending on the selected insurance company, these formalities may be different. If the patient wants to take out voluntary health insurance in the National Health Fund, the formal settlement of the matter consists of several steps:

1. filling in the application available on the NFZ website;
2. preparation of an ID card and the last health insurance title;
3. submission of the application and documents to the provincial branch of the National Health Fund;
4. after verification of documents, signing the contract;
5. payment of an additional fee;
6. 7 days from the conclusion of the contract on signing the contract for voluntary insurance with the National Health Fund, the insured should submit the ZUS ZZA form to the ZUS appropriate for his place of residence.

The proof of insurance in the above-mentioned procedure is a copy of the contract together with the proof of payment of the premium for the last month

What is medical care for coronavirus for people without insurance? Check: What is the diagnosis and treatment of coronavirus for people without health insurance?

How much does medical insurance cost?

It is very difficult to say unequivocally what is the standard premium for private medical insurance. This fee depends on many factors, including the patient’s age, health condition or expectations of the services offered. The premium for private health insurance may be as low as PLN 30, and may reach amounts over PLN 200 or 300 per month. The most expensive private medical insurance costs around PLN 500 per month.

These contributions can be compared to the amount that is taken monthly from our payout to the National Health Fund. When earning the national average, i.e. PLN 5973,75 gross, an amount of PLN 537 is collected from our salary for the health service. This is an amount that falls within the definitely higher payment ranges in insurance companies. However, please note that you cannot opt ​​out of compulsory health insurance.

How much does it cost to treat a patient with coronavirus? Check: How is the treatment of a patient with coronavirus assessed by the National Health Fund?

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