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13-06-2024

The health insurance funds: how an extra month is useful to the insured people

Iliustracija

Changes in employment, graduation and other can lead to termination of a person’s compulsory health insurance. Then, in the following month, known as an extra month, people can still be treated as insured. Only an important detail of this benefit should not be overlooked. The insurance premium must be paid before the end of this extra month to avoid paying back money for treatment later.

The Law on Health Insurance allows people to have an extra month of access to medical services paid for by the Compulsory Health Insurance Fund (CHIF) after their compulsory health insurance (CHI) has expired. But this month is an extra time to make sure you are covered. It doesn’t mean you don't have to pay the CHI premium at all: it must be paid before the end of the extra month. Otherwise, if you have received treatment or bought medicines in that month with CHIF money, you may have to repay the money for treatment or medicines later and pay missed CHI premium.

Relevant if you pay your own premium

For people with an employment contract, the employer normally pays monthly CHI premiums, so an extra month is not so important if work situation remains unchanged.
“Self-employed people who pay their own CHI premiums - those who work under certificate of individual economic activity, under a business licence or have a contract as an author - should pay attention to their insurance coverage, as they sometimes make mistakes or carelessly miss out payments. You may also have to pay your own CHI premiums if you end your employment contract, change your job, or, in particular, change the nature of your business. For example, when the employment contract ends and a person starts working under certificate of individual economic activity, etc. Then, due to an unusual situation, people may not pay that month’s premium and their insurance is terminated,” Viktorija Klinavičienė, Adviser to the Population Service Division of Vilnius Territorial Health Insurance Fund, explains.

Young people who have left school or finished full-time studies or who have dropped out of school can also face this if they do not take up other studies, do not get a job and are not covered by state funds.

CHI premium – continuously

To be able to receive treatment from the CHIF without falling into debt, CHI premium must be paid continuously - monthly instalments cannot be missed.

Suppose a person terminates his employment on 12 June. Until the end of June, he or she is considered insured and has access to all medical services paid for by the health insurance funds, reimbursable medicines and medical aids. If necessary, he or she can continue to use healthcare services paid for by the CHIF in July, which is an extra month. However, by the end of July, the patient must pay the CHI premium.

If you fail to pay – return money for treatment 

If a person uses healthcare services paid for by the health insurance funds during an extra month and does not pay the CHI premium by the end of the month, he or she will then be charged the debt for the CHI premium and, in addition, a debt for non-emergency medical care, which will have to be reimbursed.

If the service was inexpensive, such as a specialist consultation without intervention, the amount a patient has to reimburse is also relatively small - around EUR 25. However, without paying attention to the validity of the insurance, people are also turning up during an extra month for services such as surgery to remove varicose veins at a cost of over EUR 1,100, or scheduled hip replacement - currently the cost of such inpatient treatment for a simple condition is over EUR 3,200, and for a complex condition it is almost EUR 5,500. A significant amount of the refund may arise from reimbursable medicines bought during an extra month – it can be several hundred euros or several thousand euros in other cases.

First – pay your debts 

According to the representative of the health insurance funds, it happens that people, who forget to pay CHI premium, pay it the following month, thinking that they will immediately become insured again. However, this late payment is first used to cover the previous month’s debt. You only become insured again once you have paid both the premium for the additional month you missed and the premium for the current month.

The same rule applies if you miss more than one month’s CHI premiums: to take effect, you need to pay the debt of the CHI premiums for all missed months plus the current month’s CHI premium. 

How to check?

You can check whether you are covered by the CHI by entering some of your details on the website of the NHIF. For insurance status for a longer period, you need to contact your territorial health insurance fund.

You can find out how long the CHI is valid for, what medical services have been provided and how much they cost by logging in to your account on the Electronic Government Gateway.

(Freepik photo)

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Last updated: 21-06-2024

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