Health insurance FAQ
Trying to answer common and somtimes important questions
The main exclusions with private health insurance, are that the insurance does not cover:
pre existing illnesses
people with state health insurance
relatives of the insured person
mental and psychological illnesses
See below for a more complete list of exclusions.
All the insurance companies have variations on these exclusions. But at the end of the day the insurance companies are controlled by the government and Czech law.
If you wish to see the laws governing private health insurance:
Link to the laws governing Czech private health insurance.
Link to the updates of the above laws
Below are listed czech private health insurance from Ergo insurance company.
These exclusions are pretty standard for this type of insurance.
1. The insurance does not cover:
a) treatment of diseases, injuries, and other diagnosis groups that existed already before the insurance commencement;
b) the health care that is not paid as concerns the citizens of the Czech Republic who are subject to the public health insurance under valid legal regulations;
c) the health care that is provided to the Insured Person in a medical facility that does not provide such health care to the citizens of the Czech Republic who are subject to the public health insurance under valid legal regulations except for an urgent threat to life (e.g. some private clinics);
d) the expenses associated with medical drugs that the Insured Person obtains without a prescription;
e) the costs associated with cosmetic treatment and its consequences, chiropractic treatment or therapy;
f) manufacture and adjustments of prosthetic devices, orthoses, eyeglasses, contact lenses, hearing devices, and similar aids;
g) interruption of pregnancy unless there is a threat to the life or health of the woman or if the unborn child is genetically defective, i.e. where the pregnancy interruption is justified from the medical point of view;
h) treatment of infertility or sterility and artificial fertilization;
i) medical intervention and its possible consequences provided that the Insured Person went on a trip to the Czech Republic or abroad in order to undergo such a medical intervention;
j) the costs associated with the treatment provided to the relatives of the Insured Person (e.g. husband, wife, parents);
k) treatment of mental and psychological disorders;
l) spa and sanatorium treatment and rehabilitation measures;
m) the costs associated with the treatment due to application of a therapy that is not deemed to be lege artis by the medical professionals;
n) treatment of contagious venereal diseases;
o) treatment of the diseases, injuries, and their consequences caused by war events or participation in mass protests, civic disobedience events or other unrests;
p) treatment of the injuries that occur during motor vehicle driving without a relevant authorization (driving license);
q) transport, relocation or transfer by use of an air ambulance unless such a transport is approved in advance by an assistance service;
r) regulatory fees and supplementary payments;
s) treatment in connection with a committed crime or a disturbance having the character of misdemeanor; t) treatment due to a suicide or a suicide attempt;
u) intentionally caused diseases and injuries provided that they occur outside the territory of the Czech Republic;
v) injuries that occur under the influence of alcohol, drugs or other psychotropic substances outside the territory of the Czech Republic;
w) health care associated with such diseases and conditions where health care is suitable, purposeful, and necessary but it can be provided only upon the return of the Insured Person to his/her homeland.
2. The Insurer will not provide insurance payments if the Insured Person refuses repatriation, treatment or necessary medical examinations by the doctor determined by the Insurer or the Insurer ́s provider of assistance services.
3. The insurance does not cover the injuries that occur within parachuting, paragliding, jumps with a parachute from high places, use of gliders, powered hang-gliders, ultra light airplanes, shuttles, bungee-jumping, flying with balloons, hovercrafts; furthermore, the insurance does not cover the injuries that occur during the services provided by pilots, other crew members and persons who perform their service duties by the use of airplanes; the insurance does not cover scuba diving and decompression, mountain climbing , rock climbing, climbing on water and ice falls, rafting, canoeing on a wild river, canioning, ski alpinism, skiing outside marked tracks, motocross and rallies, karate, taekwondo, aikido, kung-fu, judo, box, etc.
4. The insurance does not cover the sports activities of professional athletes. Under these GTC a professional athlete is a person who carries on sports activities under a professional contract; a person who takes part in competitions, rallies, tournaments or trainings or training camps at the level of a world championship, Olympics, continent or individual countries.
5. Performance of individual activities specified in clauses 3 and 4 of this Article may be included into the insurance upon a written agreement with the Insurer or they may be insured based on additional premium under the terms and conditions of the Insurer ́s tariff.