Private health insurance – how does it work and who should use it?

Private health insurance is a type of additional insurance that is being chosen by an increasing number of Poles. Private health insurance guarantees patients faster access to doctors, tests and treatments. How does private health insurance work and what does it cover? Can private health insurance replace insurance from the National Health Fund? Who is primarily recommended for private health insurance?

Health insurance – what is it and what are the types?

Health insurance in Poland is mandatory. Polish citizens are obliged to pay health insurance contributions, thanks to which they can count on health protection and access to medical services. This access is financed from public funds.

There are two main types of health insurance in Poland. These are:

1. compulsory health insurance – that is, public insurance where monthly contributions are made to a public fund;
2. voluntary health insurance – i.e. private health insurance.

Compulsory health insurance in Poland was introduced under the repealed Act on universal health insurance of February 6, 1997.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 insurance is intended for employees and contractors as well as for persons running a business. It should also be remembered that children, pupils, students, retirees, pensioners and the unemployed are entitled to healthcare services.

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

What is worth knowing about health insurance in Poland? Check: Compulsory, voluntary and private health insurance – what do you need to know about them?

What is private health insurance?

Private health 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 without long waiting in the queue.

Contract for private health insurance signs with a specific insurance company or insurance company and, in accordance with the provisions, pays specific rates every month. The insurance company can also introduce the so-called insurance grace period, i.e. the period in which the patient cannot benefit from the insurance, despite the paid premium. This usually applies to the most expensive services, such as rehabilitation or life situations that require regular and frequent visits to the doctor.

It is very important not to confuse private health insurance with voluntary health insurance within the meaning of the Act of 27 August 2004 on health care services financed from public funds.

Private health insurance is available for patients in two options:

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 or offered by employers.

Private health insurance usually covers:

1. medical insurance – guarantees outpatient treatment;
2. hospital insurance – allows hospitalization in a facility with a higher standard;
3. medical cost insurance (KL) – provides reimbursement of costs related to treatment.

The number of Poles who opt for private health insurance is constantly growing. According to the estimates of the Polish Chamber of Insurance, about 2013 thousand people used private health insurance in 750. people. In the first half of 2020, such insurance was already used by over 3 million Poles, i.e. by 13,1 percent. more than a year earlier.

Are there medical subscriptions and when are they worth choosing? Check: Medical subscriptions – how much does it cost and when does it pay off?

How does private health insurance work?

Private health insurance is an additionally payable supplement to the obligatory and public health insurance guaranteed by the National Health Fund. It is worth remembering that private insurance is not an alternative to compulsory insurance, it does not replace it, but both can be used at the same time.

Private health insurance is usually concluded for a period of 12 months. The contract is automatically continued as long as the patient does not terminate the contract in writing 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.

The purchased private insurance covers the patient’s costs of health services provided in medical facilities indicated by the insurer.

How does private insurance work? In a situation where the patient wants to make an appointment to see a doctor, he should call his insurance company at the number provided by the insurer. After connecting, personal data will be verified, and then the patient will be asked which specialist he wants to make an appointment and in which city the visit is to take place. During this conversation, it is worth emphasizing the urgency of the visit to the consultant.

In the case of private health insurance, the patient usually has the option to choose his preferred doctor from the list of specialists who work or cooperate with the facility. After making an appointment, the patient’s only task is to come to the office on a specified date. The patient should have an ID card or passport with him to verify his identity.

When using private health insurance, remember about its operation in a life-threatening situation. In the event of emergencies, the public health service is given priority. If, for example, a heart attack or a car accident occurs, the patient will be automatically redirected to a hospital belonging to a given local government unit. Which, in the absence of NFZ insurance, may result in a very large bill for the implemented treatment.

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

What does private health insurance cover?

Private health insurance usually covers medical diagnostics, visits to specialist doctors, and procedures. However, with most insurance companies, private health insurance covers more services. Among them are:

1. visit to a primary care physician – this applies to internal diseases, family medicine, pediatrician and nursing procedures;
2. a visit to a specialist healthcare doctor – this applies to a visit to a surgeon, oncology surgeon, ENT specialist, neurologist, ophthalmologist, oncologist, pulmonologist, urologist, allergologist, anesthesiologist, vascular surgeon, dermatologist, hematologist, cardiologist, orthopedist, proctologist, rheumatologist, diabetic surgeon, neurologist, endocrinologist, gastroenterologist, nephrologist or a gynecologist;
3. performing imaging tests – this applies to X-ray images, ultrasound examinations, functional examinations, endoscopy, computed tomography, magnetic resonance imaging;
4. performing laboratory tests – this applies to hematology, biochemistry, tumor markers, urine testing, diabetes diagnosis, hormone levels, serology and microbiology;
5. medical assistance service – these are medical and nursing visits at the insured’s home;
6. private ambulance service – it concerns operations and procedures in private medical institutions;
7. vaccinations – especially against influenza, hepatitis A and hepatitis B, measles, rubella, mumps, tick-borne meningitis and encephalitis;
8. preventive actions and examinations – for women, it is usually cytology, breast ultrasound, mammography, while for men – cardiological tests, lipidogram, heart ECHO or exercise test;
9. rehabilitation – treatments after fractures and sprains or other injuries of the locomotor system.

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

What is not covered by private health insurance?

Private health insurance, despite the wide range of services available, does not cover all injuries or damage to health. Insurance companies clearly indicate when a patient cannot count on access to benefits or reimbursement of treatment costs. Such situations include:

1. self-mutilation or mutilation of the body at one’s own request;
2. suicide attempts;
3. concealing the disease when signing the contract – e.g. cancer or other chronic disease;
4. failure to follow the doctor’s instructions;
5. consumption of alcohol, drugs and other substances harmful to health;
6. the effects of using drugs against the doctor’s recommendations;
7. events caused by an accident;
8. situations arising from the commission of a crime or its attempt
9. sex reassignment treatments;
10. birth defects;
11. drug addiction treatments;
12. abortion;
13. infertility treatment;
14. participation in medical experiments.

Private health insurance usually does not cover treatment of diseases such as: HIV virus, AIDS syndrome, tuberculosis, heart attack, circulatory failure, stroke, malignant neoplasm, diabetes, multiple sclerosis, Alzheimer’s disease.

Does private health insurance replace medical care from the National Health Fund?

Private health insurance does not replace compulsory insurance under the National Health Fund. Every person legally working in Poland is obligated to pay contributions and cannot be exempt from these fees.

Due to the fact that treatment under the National Health Fund is often associated with quite a long wait for the visit, dissatisfaction with treatment or quality of services, insurance companies offer private health insurance. They are a voluntary supplement to compulsory insurance, but cannot replace it.

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?

Private health insurance – who should take advantage of it?

Private health insurance is a type of service that anyone can use. Insurance companies have prepared offers for people between 18 and 65 years of age. Detailed conditions concerning the insured person’s age are regulated by the GTC document, which is attached to the insurance.

While everyone can use the services of Health Insurance Companies, for some people additional insurance may be especially useful.

Private health insurance is a very good solution for people who use medical services several or several times a year and are not satisfied with the services offered to them under the NFZ insurance.

In addition, private health insurance is useful for parents who have pre-school children. Private insurance guarantees a faster and more comfortable visit to the pediatrician. You don’t wait longer than a day for an appointment with a pediatrician, you avoid waiting in a waiting room, and you get a quick diagnosis and prescription.

Private health insurance is the optimal solution for people who visit a doctor more than once a month or who often need to consult a specialist. When making an appointment at the National Health Fund, you have to wait up to several months for an appointment with an endocrinologist or a neurologist. Therefore, patients much more often use private visits. In order to save money and time, it is worth investing in private health insurance, because then only the cost of insurance is incurred, and you do not have to pay for each subsequent visit.

Private health insurance is also recommended for those people who frequently perform laboratory tests in order to monitor their health. Some of the tests are quite frequent, such as blood count, blood glucose tests, cytology, colonoscopy, urine tests, and lipid profiles. The purchase of private health insurance will allow you to quickly sign up for examinations and, as in the case of frequent visits to specialists, it does not require paying for the examination each time.

What tests should be performed on a regular basis? Check: Eight tests worth doing at least once a year

Private health insurance and the National Health Program

Speaking of private health insurance, mention should be made of the National Health Program, which offers clear conditions for everyone who joins it. A patient who reports to the National Health Program pays a fixed monthly fee of PLN 49, and if there is a need to consult a doctor or perform an examination, from several to several dozen zlotys for a medical service.

This insurance can be purchased from an advisor by phone, internet or stationary. The KPZ policy provides access to almost 2000 branches throughout the country.

In the case of using the services of the National Health Program, the prices for individual visits or tests are as follows:

1. medical consultation – PLN 19,90;
2. medical treatments – from PLN 29,90;
3. laboratory tests – from 9,90 PLN;
4. X-ray-ultrasound imaging tests – from 49,90 PLN;
5. endoscopic examinations – from PLN 79;
6. functional tests – from PLN 29,90.

The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.