Health insurance in Europe: how it works

Czech Republic

Insurance policy is compulsory for both citizens and foreigners staying in the country for more than 90 days. There is a system of public insurance (Russian-speaking sources more often call it state insurance), and those who cannot participate in it, purchase commercial insurance.

Veřejné zdravotní pojištění (public health insurance) is available for:

• Czech citizens;
• holders of permanent residence permits (trvalý pobyt);
• foreign citizens without permanent residence permits who are employed by Czech companies (their insurance ends on the day of dismissal);
• potential refugees, who are insured from the moment they apply for asylum.

Representatives of all of the above categories are obliged to have public insurance and cannot give it up in favor of commercial insurance.

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What is the difference between public and commercial insurance

Public insurance companies work on the principle of solidarity: everyone contributes the same percentage of their earnings to form a fund from which claims are compensated. Due to the fact that a certain percentage of participants rarely or not at all seek help, the insurance company is able to pay for all its clients, regardless of their wealth and the amount of their contributions, expensive treatment when necessary.

The principle of operation of commercial insurance companies can be described by the phrase "every man for himself". Payments per insured event are limited to a limit (from 60,000 to 100,000 euros), which the insurance company will not exceed. If the money runs out and there is no treatment, it is the patient's problem. Emigrants sadly joke that it is better for the unemployed not to fall ill with anything more serious than acute respiratory infections until they receive a residence permit.

Another important difference is that only public insurance covers the treatment of illnesses that occurred before the insurance policy started. Commercial insurance holders have to deal with chronic problems at their own expense, which often leads to significant expenses.

Commercial insurance is cheaper than public insurance, but it is also less useful.

What insurance companies are available

Participants in the public insurance system can choose from seven companies (the most popular is VZP, which is also the guarantor in case of bankruptcy of the others) and change them freely. Exceptions are newborn children, who automatically become clients of the insurance company where their parents are insured, as well as active military personnel and cadets (they are assigned to the VoZP insurance company). The scope of coverage is the same for all insurance companies (it is regulated at the legislative level), so they attract clients with bonus programs. For example, they pay for sanatorium treatment, preventive measures, optional vaccinations, etc.

There are more differences between sellers of commercial policies: the size of the limit per insured event, the list of what is and is not covered, the number of preventive visits to doctors, the list of contracted medical institutions, and the cost of services. The top looks like this: PVZP (the most expensive), Uniqa, ERGO, and Maxima.

What are the different types of commercial insurance

Základní zdravotní pojištění. This is the cheapest basic insurance that covers only emergency cases. Roughly speaking, you will not be allowed to die, but they will not prevent or treat non-life-threatening illnesses.

Komplexní zdravotní pojištění. This is a comprehensive insurance, which, unlike the basic insurance, includes preventive examinations by a general practitioner/pediatrician, gynecologist and dentist, mandatory vaccinations according to the national calendar, dental treatment (though for a very small amount and only in case of acute pain), pregnancy management and childbirth, tests, examinations and medicines prescribed by a doctor.

There are special insurances for newborns (they are valid for several months, cover the child's stay in the maternity hospital and all related medical manipulations), as well as for professional athletes.

What insurance does not cover

Public and commercial insurers are in solidarity when it comes to the scope of coverage. In most cases, expenses for:

• Plastic surgery. The only exceptions are surgeries that are performed for medical reasons, for example, breast reconstruction after its removal;
• cosmetic procedures;
• homeopathic treatment;
• acupuncture;
• vitamins, dietary supplements, contraceptives and over-the-counter medications;
• registration of certificates for kindergarten, school, medical examination for registration of a driver's license, etc.

Dental treatment is covered only in case of acute pain and within the limit (5,000-6,000 kronor / 195-235 euros per year). If you don't want to end up with pulpitis, you will have to pay for dental check-ups and timely repairs.

What is partially covered

Drug costs. All insurance companies reimburse the cost of medicines in the amount set by the Ministry of Health. This amount may differ from the cost of the drug in pharmacies by 2-3 times, the difference is borne by the patient. The good news is that for treatment of most common diseases there is at least 1 drug that the insurance company will pay for in full.

How to use insurance

Let's start with the main thing - there is a fee for an ambulance. Insurance companies cover it only if the patient's life and health were in danger and he or she could not get to a doctor on his or her own. In all other cases, the person goes to the nearest ambulance (pohotovost) and waits for an appointment. Those whose condition is alarming are admitted first, while the "lungs" sometimes spend 5-6 hours in the corridors.

If the situation is not so critical, the sick person is referred to a general practitioner (praktický lékař pro dospělé) or a pediatrician (praktický lékař pro děti a dorost). They will give you referrals to specialists, examinations or tests, if necessary. It is usually easy to get an appointment with a general practitioner or pediatrician, but appointments with an endocrinologist, orthopedist or neurologist can take from a month to six months.

If the situation allows, commercial insurance holders should first call the assistance service, the number of which is indicated on the insurance card. After listening to complaints, the operator will refer the patient to a doctor, emergency room or call an ambulance. In this case, you usually do not have to pay - a letter of guarantee is sent to the doctor or clinic. If you choose a doctor with whom the insurance company does not have a contract, you will have to pay for the services yourself, and then send the documents and wait for compensation (the application is considered for up to three months).

Those who have public insurance must be registered with a specific general practitioner/pediatrician and can change them no more than once every 3 months. Once they have asked for help, in most cases they will receive it at the expense of the insurance.

How much the insurance costs

Public insurance is free for:

• children under 18 years of age;
• students up to age 26;
• Persons over 25 years of age who are pursuing graduate or postdoctoral studies;
• Retirees over 65 years of age;
• parents on parental leave;
• unemployed parents of one child under 7 years of age or two or more children under 15 years of age;
• unemployed persons who are registered with the stock exchange;
• persons with disabilities and their guardians;
• convicted persons, prisoners and those undergoing compulsory treatment;
• asylum seekers, as well as unemployed refugees and their children born in the Czech Republic.

Those who work in Czech companies, insurance costs 13.5% of the salary (gross): 9% is paid by the employer and 4.5% by the employee.

Unemployed public insurance participants who are not registered at the labor exchange, businessmen and self-employed pay 1,647 kronor (65 euros) per month, which is 13.5% of the minimum wage. The amount of the premium is adjusted annually to reflect the increase in the minimum wage.

The cost of commercial insurance depends on its type (basic, comprehensive), age and gender of the insured, the purpose of stay in the country, the duration of the policy (the longer it is, the cheaper it costs each month), the coverage area (only Czech Republic or Czech Republic + Schengen countries). And, of course, from the chosen company: if ERGO's policy for a year costs 10,200 CZK (400 euros), PVZP's policy costs 17,500 (685 euros).

Germany

Germany is the birthplace of social insurance. In 1848, the first insurance fund was opened in Berlin to serve police officers, and in 1883, on the initiative of Chancellor Otto von Bismarck, the "Law Concerning Workers' Hospital Insurance" was adopted. Since 2007, everyone in the country is obliged to have health insurance, which can be taken out at a public or private insurance fund.

What is the difference between public and private insurance

Those who earn less than 59,400 euros a year (this limit is reviewed annually) can only be insured by a public insurance fund, those with a higher income, as well as private entrepreneurs, freelancers and civil servants, are free to choose between public and private insurance.

According to statistics, almost 90% of German residents are clients of state insurance funds. There are now 118 of them (in 1970 there were 1815), the most popular being AOK, Techniker Krankenkasse, Barmer GEK and DAK-Gesundheit. The scope of coverage is 95% the same, the remaining 5% are bonus programs: payment for unconventional treatments, etc. The main advantage of the state insurance is that it is free of charge for family members if a number of conditions are met.

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The state insurance funds operate on the principle of solidarity: the funds contributed by all participants in the insurance system are added up and distributed among the funds in equal shares. If this amount is insufficient for a particular fund, all its clients have to pay an additional fee: minimum 8 euros, maximum 1.9% of income per month. You cannot refuse to pay the surcharge, but you can terminate your contract early and change your insurance fund. In other cases, you can switch to another insurance company not earlier than 18 months after signing the contract.

There are 41 private insurance companies in Germany, the largest ones are Debeka, Deutsche Krankenversicherung, Axa, Allianz Private Krankenversicherung, Signal Iduna. The disadvantage of such insurance is that you have to buy it separately for each family member, but the advantages are more: extended coverage (teeth whitening, purchase of contact lenses, etc.), the ability to see doctors who accept only clients of private insurance companies, and to visit narrow specialists without long waiting times. Having private insurance is beneficial while you are single, young, healthy and earning a lot (its cost is not linked to income, which is attractive for those with high salaries), but as you get older or have a child/unemployed spouse, it can put a hole in your budget.

Before deciding to buy, it is worth thinking about plans for the future: you can return to the state fund only if at least a year of income will be below the established limit.

What is supplementary insurance

The client of the state fund can enter into a private contract that provides for the payment of services that are not covered by the main policy. For example, dental treatment, caregiver services, etc. In this case, the income can be any, it does not affect the ability to take out insurance.

How much insurance costs

The state insurance costs 14.6% of the insured's "rough" annual income; for those who are employed, the employer pays half of it. The insured pays an additional contribution (about 1% of income). The rate is the same for everyone, regardless of salary, so that people with different income levels can expect the same medical care.

Most pensioners pay 8% of their pension for insurance, but those with high pensions pay the standard 14.6%. But for the unemployed, recipients of minimum and social pensions, the insurance is free of charge - the state pays for them.

The monthly fee for private insurance is calculated individually. It does not depend on income, but is linked to age and health condition.

How to save money

For those who take care of their health (regular visits to the dentist, swimming pool or gym), some insurance companies increase the % of compensation for medical services. For example, they pay not 70, but 80 or even 90% of the cost of dental treatment.

How to use the insurance

An insurance policy is a chip card (versicherungskarte), which contains data about the insured person. It must be carried with you at all times, as the doctor or pharmacist who sells prescription drugs reads the information from it using a special device.

Basic services are free for public insurance holders. Some services, as well as medicines prescribed by a doctor, require additional payments, but in total, such additional payments should not exceed 2% of income per year (1% for chronic patients). Children under the age of 18 are exempted from surcharges, and medicine is 100% free for them.

If the insurance is private, you will have to pay for treatment out of your own pocket and then ask for reimbursement. Sometimes the amount is partially refunded or not refunded at all.

Switzerland

Everyone who stays in the country for more than 3 months is obliged to take out a basic medical insurance. You can choose a company at your own discretion (there are 63 of them, the largest are Aetna, Allianz and Cigna): the amount of monthly payments varies from canton to canton, but the amount of coverage is the same for all of them. By law, insurers are not allowed to go overboard: they are obliged to sell basic insurance to everyone, without regard to age, lifestyle or health.

If the newcomer has not chosen an insurer himself, the local administration will appoint one. You can only change companies at the end of the year by giving at least one month's notice of your intentions.

What is additional insurance

Insurance companies differ not only in prices, but also in the availability of additional packages. For a fee, you can get extended coverage (say, to transfer to the insurance payment for expensive dental services), provide yourself with a more comfortable room and additional care in case of hospitalization, etc. These insurances are not compulsory and can be taken out with your own or any other company. The price depends on the state of health and the list of services.

How much insurance costs

Insurance in Switzerland necessarily includes a deductible - the amount up to which the patient pays for medical services himself. The deductible can be from 300 to 2,500 francs (265-2,215 euros), the smaller it is, the more expensive the insurance. The average insurance premium in 2017 was 447 francs (about 400 euros) per month.

The cost of insurance varies from canton to canton. The most expensive are Basel (average 567 francs / 500 euros per month), Geneva (554 francs / 490 euros), Vaud (495 francs / 438 euros), Jura and Basel-Land (488 francs / 432 euros). The cantons of Zug and Obwalden (376 francs / 333 euros), Uri (369 francs / 327 euros), Nidwalden (361 francs / 320 euros), Appenzell-Innerrhoden (348 francs / 308 euros) pay the least for insurance.

Each family member must be insured individually.

How to save money on insurance

1. Buy a policy with a limited choice of doctors and clinics (HMO).
2. Choose a Telmed policy, which requires owners to call and follow the advice of a physician's office before each visit.
3. Choose a policy with a maximum deductible. An option for the young, healthy and risky - if you fall ill, you will have to part with an impressive sum.
4. Get a discount if your earnings are below a certain level.

What the insurance does not cover

Basic policy holders pay for eyeglasses and contact lenses (except for vision problems caused by an accident or chronic disease), dental treatment (a filling costs from 200 francs / 177 euros), contraceptives, preventive appointments with a gynecologist more than once every 3 years, over-the-counter drugs, hearing aids. But unlike many other European countries, the insurance company will not deny compensation to those who have chosen alternative methods of treatment.

How to use the insurance

When you go to an appointment, you should take your health insurance card with you. If the doctor or clinic does not have a contract with the insurer, you will have to pay for the services yourself and then apply for compensation. First, the deductible is spent, and when the amount is exhausted, the insurance company starts paying. The patient pays 10% of the cost of treatment (up to a maximum of 700 francs), as well as the clinic stay (about 15 francs / 13 euros per day).

As a rule, you are free to choose a doctor. The exception to this is for those with low-cost insurance, who are obliged to use certain medical facilities.

In acute cases, you should go to the nearest emergency room (Notaufnahme), which is likely to be open 24 hours a day. "You can also call an ambulance, but you will have to pay 850 to 1,900 francs (€750 to 1680). The insurance reimburses only half of the sum, the limit is 500 francs (€440) per year.

What is the situation in Ukraine?

Until the issue of compulsory health insurance is not settled at the legislative level, each of us has to rely only on ourselves. But if it is possible to cope with ordinary diseases, like acute respiratory viral infections, without any problems - there are a lot of such services, then the case with serious diseases is more complicated. Oncological diseases or heart problems in our country are very expensive, equipment and diagnostics leave much to be desired. But recently there have appeared interesting programs for such cases, for example, the insurance program for critical illnesses "Medicine without borders" from AXA Insurance.

For quite acceptable €225 per year you buy peace of mind for yourself and your loved ones. In this case, if something happens, treatment will be organized in the best clinics of the world, such as Berlin "Charite", with consultation of experienced doctors, full support, and the amount of payments will be up to € 1 000 000.

Find out what the policy covers