In health insurance, the insured has a number of obligations towards "his" health insurance company (see § 10 a § Section 12 of Act No. 48/1997 Coll., on public health insurance).
One of them is the obligation to notify within 8 days the facts decisive for the state's obligation to pay insurance premiums on behalf of the insured. In other words, it is a notification that the insured is entitled to be classified as a state insured. If this fact is known to the employer, it is the employer who is obliged to make the notification. However, if the employee discovers that the employer has not complied with its obligation (e.g. by making enquiries with his employer or the health insurance company), then it is the employee who is obliged to notify.
For the purposes of health insurance, a pensioner shall be deemed to be a pensioner under § Section 7(1)(b) of the Public Health Insurance Act a person who was granted a pension before 1 January 1993 under the regulations of the Czechoslovak Socialist Republic and after 31 December 1992 under the regulations of the Czech Republic, or also under the regulations of the Slovak Republic, but only if the pension was calculated taking into account the period of employment before 1 January 1993 with an employer established in the territory of the common state. A person shall be deemed to be a beneficiary of a pension under the preceding sentence even in months when he is not entitled to the payment of a pension under the pension insurance regulations.
In the above cases, the pensions are pensions under Act No. 155/1995 Coll., on pension insurance:
- old age
- Disability
- widow's, widower's,
- Orphanage.
The pensioner is entitled to the payment of insurance premiums by the State from the time the pension is awarded until the pension is withdrawn by decision. From 1 January 2016, the state pays a premium of CZK 870 per month (i.e. 13.5% of the assessment base of CZK 6,444) to the health insurance company for such a person - see § 3c of Act No. 592/1992 Coll., on health insurance premiums a Government Decree No. 158/2015 Coll., on determining the assessment base for a person for whom the state is the payer of public health insurance premiums.
What forms should I use to report the change to the health insurer?
If the insured person reports the fact that he/she has become a pensioner, he/she will use the appropriate form (e.g.Application form and insurance registration sheet", at the ZPMV ČR."Notification by the insured of a change in data").
If the employer of the insured person reports such a fact, he/she will use the form "Employer's mass notification" and into code changes completes "D".
In payroll and HR software AVENSIO Software you can of course conveniently process the "Employer mass notification" form in the menu Main menu - Press reports - Health insurance companies. The form can be both printed and processed for subsequent electronic submission.
In this context, I would like to remind all users of the above-mentioned programme that the classification of an employee in the state category for the purpose of pension is recorded on his personal card - tab "Personal data" - area "Health insurance" - field "ZP relief".
