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17-03-2021

Klaipėda Territorial Health Insurance Fund has identified the most important points about compensation for damage to the Compulsory Health Insurance Fund budget

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It is useful for everyone to know in which cases damage to the budget of the Compulsory Health Insurance Fund (CHIF) may be compensated. The specialists of the Klaipėda Territorial Health Insurance Fund  (Klaipėda THIF) advise what to do in order to have no need to compensate for damage, and, if damages are done, how to minimize monetary losses and inconveniences.

All troubles and loss of money can be avoided by knowing just two rules. The first is to take care of your own health insurance, i.e. pay compulsory health insurance (hereinafter - CHI) premiums in a timely manner, so that if a necessity appears, you could be legally treated both in Lithuania and in the European Union (EU) countries and would not pay for what the patient fund pays with CHIF money. The second rule is not to commit offenses, that is to say, not to act in a way that could harm other people. The funds spent on their treatment are recovered from the offender, and the amounts can reach from a dozen to several tens of thousands of euros.

Under current arrangements, the territorial health insurance funds (THIF) are responsible for recovery of damages. This is done in the following cases: if the damage was caused by illegal activities — crimes or misdemeanors against human life, health, public policy, transport safety, when, as a result of all these events, victims or other persons insured by the CHI were treated with CHIF funds, due to illegal use of a European health insurance card (EHIC), as well as cases when a person, being uninsured, unlawfully receives health care services paid for by the CHIF budget in Lithuania or abroad.

Victims and treated persons are reported to THIF by police commissariats, prosecutors' offices, and bailiffs recover the money spent on victim from the offender treatment and return them to the CHIF.

The greatest damage to human health, and at the same time to the CHIF budget, is caused by those who are not sober, prone to violence and irresponsible driving. If a drunk person sitting at the wheel of a car causes an accident involving damages to people's health, the CHIF funds are used by the patient fund to pay for their treatment. This is also the case when the person responsible for the traffic accident drove an uninsured vehicle. The entire amount spent on the treatment of victims shall be recovered from the perpetrator or, in the case of a minor, from parents or guardians. If the injured are to be treated initially in the hospital, then continue treatment in rehabilitation, the amount of damage reaches several tens of thousands of euros. Thus, the culprit can lose both savings and a significant part of income.

In the event of an accident, if a person was injured, the recovery of the damage takes place in several stages: first the employees of the THIF calculate the amount of damage, then file a civil claim against the perpetrator in court if the vehicle was not insured, or submit a claim to the insurance company if the vehicle was insured. In this way, the cost of treatment of injured persons in a car accident is reimbursed to the CHIF budget either by the perpetrator of the traffic accident or by the insurance company.  

Damage to the CHIF budget is also caused by the illicit use of the EHIC while staying abroad. This happens if a person who is not insured by CHI in Lithuania presents a card to an EU medical institution and is provided with the necessary medical assistance. The CHI recalls that persons uninsured in Lithuania (i.e. having ceased to pay CHI contributions in Lithuania and having lost their insurance) cannot use the EHIC even if the card has not yet expired. The card guarantees payment for treatment only as long as the person is insured.

CHI specialists who calculate the amount of damage claim that the amount to be reimbursed depends on the amount and prices of the treatment services provided to the injured person: for example, in 2020 the minimum amount of the awarded and recovered damage to the CHIF budget of Klaipėda THIF was 20 EUR, and the largest — over 19 thousand Eur.

In 2020, the Klaipėda THIF examined 2 323 cases of damage to the CHIF budget, total damage amounted to EUR 538 703 Eur. Of all the reports received, 810 cases were treated for victims of illegal activities (bruises other injuries) and traffic accidents, and damage to the CHIF budget amounted to EUR 380 789. 42 notifications were received as a result of the unlawful use of the EHIC, and the damage was EUR 16 946. The receipt of illegal healthcare services, when persons were not insured, resulted in registering 1 471 notifications, the damage is estimated at EUR 140 969, of which EUR 102 548 was recovered/voluntarily compensated. This accounted for as much as 72.74 per cent of the CHIF budget funds being refunded.

In total, 2.5 million euros were returned to the CHIF last year — 77 thousand euros more than in 2019.

THIF points out that the extent of the damage depends on the amount of provided treatment services that were paid for by the CHIF and the prices pf services effective at that moment. If it so happened that a person caused damage to the CHIF budget, there is an opportunity to compensate it voluntarily. In criminal or civil matters, parties may reconcile and terminate proceedings. If reconciliation fails, voluntary compensation of damage is a mitigating circumstance for the offender in court. After receiving a notification and a call for good will compensation of the damage to the budget, the perpetrator may choose either to reimburse the full amount immediately or to come to the THIF and sign a contract for compensation in instalments. Such a contract may be concluded if the amount of damage caused is not less than 300 Eur and the period of compensation is not more than 5 years.

Klaipėda Territorial Health Fund information

The NHIF invites you:

Your questions are welcome by email [email protected] or phone: local (8 5) 232 2222, international +370 5 232 2222.

Last updated: 27-05-2021

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