Reminded of the importance of compulsory health insurance contributions and the possibility of checking insurance coverage

Our universally paid monthly health insurance contributions make it possible for all insured people to have their healthcare covered by the Compulsory Health Insurance Fund. What happens if this contribution is not paid and how to find out if you are covered?

An employer pays compulsory health insurance (CHI) contributions for people working under employment contracts, self-employed people pay for themselves and the state pays this contribution for a certain part of Lithuanian population, i.e. for minors, full-time students, people with disabilities, people receiving old-age pensions, other pensions or social assistance compensations, and unemployed people registered with the Employment Service.

Until CHI contributions are paid, all these people are insured. Medical services, prescribed reimbursed medicines and medical aids provided to them in medical institutions, that have an agreement with the health insurance funds, are covered by the health insurance funds. However, if at least one CHI contribution is not paid, person’s insurance is terminated, and he/she has to pay full cost of medical services by himself/herself. In such cases, only emergency medical aid is provided free of charge if patient’s life or the lives of others are at risk or if serious complications could arise if a person is not treated on time.

“To avoid unexpectedly paying hundreds or thousands of euros for medical treatment when somebody gets sick, injured, or ill, people should check whether their health insurance is valid. This is especially important in times of life changes. For instance, when school or studies are finished, when coming back to live in Lithuania, terminating employment contract, becoming self-employed or without a new employment contract for more than one month. In such cases, you may have to pay a fixed amount of CHI by yourself each month, and it is important that you pay it by the end of a current month. Failure to pay the contribution on time will result in termination of the insurance,” says Viktorija Klinavičienė, Advisor of Population Service Division of Vilnius Territorial Health Insurance Fund.

You can check whether your compulsory health insurance is valid on the website https://dpsdr.vlk.lt. After filling in the form, it is shown whether a person is insured at the time of the check. Those, who can verify their identity electronically, by logging in to their account on the e-Government Gateway Portal, can see detailed information on the validity of their health insurance, healthcare services they have received and the cost of those services.

According to V. Klinavičienė, when people have doubts or questions about the validity of their CHI, they often turn to the health insurance funds. Once a person’s identity has been established, the health insurance funds check in the Register of Persons Insured with Compulsory Health Insurance whether he or she is insured, explains on what basis he or she is insured and for how long, and explains why the insurance has been terminated or why it is shown in the Register as invalid.

Compulsory health insurance is usually restored within 2-3 days once the outstanding balance of CHI contributions and the current month’s contribution have been paid, or the missing documents proving that the person needs to be covered have been provided. For example, a young person studying in another European country provides the health insurance funds with an official certificate from the educational institution stating that he/she studies there.

The health insurance funds also remind that, because of the increase in the minimum wage, from 1 January 2024, the CHI contribution for the self-insured will be EUR 64.50. If CHI contribution is not paid to SODRA by the end of a current month, health insurance will be terminated and the health insurance funds will not be able to pay for medical services, medicines and medical aids provided to such a patient.

(Pictochart photo)

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