Ministry of Economic Development, Labour and Technology

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Eligibility to health care services

In Poland, medical services are provided by public and non-public service providers.

The following persons are entitled to use publicly-funded health care services:

  1. Persons covered by the Polish universal (compulsory or voluntary) health insurance provided by the National Health Fund (Narodowy Fundusz Zdrowia, NFZ), hereinafter referred to as "insured persons".

Both Polish citizens and EU/EFTA Member State citizens who reside in an EU or EFTA Member State can be insured. Family members of the aforementioned persons who reside in Poland or an EU or EFTA Member State other than Poland are also insured unless they are subject to obligatory insurance in Poland or entitled to health care services under the Community provisions on the coordination of the social security systems.

Every EU or EFTA Member State citizen who is subject to health insurance in Poland must obtain his/her PESEL number as all Polish citizens.

The PESEL (Universal Electronic System for Registration of the Population) number is an 11-digit symbol which identifies a natural person. The number consists of the following components: the date of birth, an ordinal number, a number denoting sex and a check digit. If applicable provisions of law require a person to have the PESEL number, it is assigned ex officio upon registration of residence or at a justified request submitted to the competent communal or city office( respectively urząd gminy or urząd miasta).

Obligatory health insurance applies to inter alia employees, persons who perform work under an agency contract, a commission contract or any other service provision contract, persons who conduct business activities, excluding those who have suspended their business activities, persons who receive pensions, pupils, students and PhD students, unemployed persons, persons receiving certain types of social benefits or certain family benefits. A person who resides in Poland can take out voluntary insurance by signing a voluntary health insurance agreement with the Provincial NFZ branch of his/her place of residence in Poland.

Insured persons are obliged to register their family members for health insurance (i.e. their natural children; adopted children of up to 18 years of age or up to 26 years of age if the children continue their education; their spouse; their ascendants who live in the same household with the insured person), unless they have their own health insurance. Grandparents may register their grandchildren for health insurance only if neither of the parents is subject to the health insurance obligation or eligible for health care services under the provisions on the coordination of employment or self-employment or voluntary insurance.

  1. EU or EFTA Member State citizens who are not covered by the universal health insurance in Poland and are covered by the health insurance of another EU or EFTA Member State during their temporary stay in Poland.

During their temporary stay in Poland, e.g. for the purpose of studying or looking for a job in Poland (provided that in the latter case they receive unemployment benefits in another EU or EFTA Member State), these persons are eligible for free health care services upon presenting the European Health Insurance Card. However, this applies only to services which may be deemed essential for medical reasons taking into account the nature of these services and the expected length of stay in Poland.


Health insurance contributions

Insured persons pay health insurance contributions in the amount of 9% of the levy basis (e.g. the income reduced by social insurance and pension contributions, or at least 75% of the average monthly salary in the enterprise sector, as published by the President of the Statistics Poland – for persons carrying out a non-agricultural economic activities). Health insurance contributions are paid by employers, Social Insurance Institution (Zakład Ubezpieczeń Społecznych) and other pension insurance companies, social assistance centres, schools and higher education establishments etc. (contributors).

Using health care services

Persons eligible for publicly-funded health care services in Poland (beneficiaries) may use such services only in health care institutions which have signed a contract with the National Health Fund. Such contracts are held by a vast majority of health care establishments in Poland. If emergency health care services are provided by an establishment which does not have a contract with the National Health Fund, the beneficiary has the right to these services to the extent necessary.

A beneficiary chooses his/her primary health care (podstawowa opieka zdrowotna, POZ) doctor, nurse and midwife by submitting a written declaration. The first appointment at the selected health care facility usually involves registration and selection of a primary health care doctor.

In order to complete the registration, it is necessary to verify the patient’s eligibility for health care services. This is done by the health care facility in the electronic eWUŚ system (Electronic Verification of the Beneficiaries’ Rights), which enables to immediately confirm whether the patient is eligible for publicly-funded health care services. Eligibility for publicly-funded health care services is verified on the basis of the patient's PESEL number and a document confirming his/her identity e.g. an ID card, passport, driving licence or a valid school ID for children of up to 18 years of age who are subject to compulsory school attendance.

If it is not possible to verify the patient’s eligibility in the electronic system, the patient must present a document confirming the he/she is covered by health insurance, e.g. the ZUS RMUA form. If the patient does not have such a document, he/she may submit a written declaration on his/her eligibility for health care services.

Scope of health care services and emergency telephone numbers

Health care services can be provided by both public and non-public entities which have relevant contracts with the National Health Fund. Publicly-funded health care services include:

  • health services meant to maintain, save, restore and improve health as well as other medical actions arising from the treatment process or legal regulations, as defined by the Minister of Health;
  • health services in kind – medications and medical devices related to the process of treatment – provided for a partial payment, paid for on a flat-rate basis or paid in full,
  • treatment-related services – accommodation and meals, medical transport services at 24-hour or day health care establishments.

POZ doctors manage basic treatment and, if necessary, refer their patients to other specialists. An insured patient without a referral from his/her primary health care doctor can use health care services of the following specialists: gynaecologists and obstetricians, dentists (very few dental services are paid for by the NHF), venereologists, oncologists, and psychiatrists. In emergency situations, health services are provided without the required referral. A referral is also necessary if hospital services are required (it is not necessary in the event of an accident, injury, poisoning or other life-threatening situations). During hospitalisation, procedures, tests and medicines are provided free of charge.

The 24h emergency call centre number, available across Poland, is 112.

Most tasks involving provision of health service information have been taken over by the recently launched Telephone Patient Information (Telefoniczna Informacja Pacjenta). Available country wide at the same telephone number, it also offers consultations with the Office of the Patients' Rights Ombudsman.

Information on health care establishments which have contracts with the National Health Fund can be obtained from provincial branch offices of the NFZ. Telephone numbers of individual NFZ branch offices are available on the NFZ website.

Payments for health care services and medications

Health care services covered by the universal health insurance are provided free of charge unless applicable regulations provide for a partial payment by the beneficiary.

The services which are explicitly indicated in the national legislation as not provided under health insurance are paid for. They include e.g. services which are provided in spa-treatment establishments to insured persons without a referral to this kind of treatment; travel and accommodation costs of spa treatment – the beneficiary must pay full costs of travel to and from the spa treatment establishment and partial costs of food and accommodation in the sanatorium; preventive vaccinations other than listed in the regulations on infectious diseases and infections. The provision of medical devices such as prostheses, spectacles, wheelchairs etc. is limited in terms of quantity.

Free-of-charge medications are provided to an insured person who has been admitted to a hospital or another health care facility for patients who need a 24-hour or day medical care, and during health, nursing, diagnostic and rehabilitation procedures which are conducted by entities authorised to provide services covered by health insurance, as well as in the case of emergency assistance provided by those entities.

To purchase medications at a reduced price, it is necessary to present a prescription issued by a doctor or medical assistant (felczer), nurse or midwife, provided that they are licensed to practice the profession.

Medications are dispensed at pharmacies, usually on the basis of prescriptions issued by authorised persons:

  • free of charge, or
  • upon making a flat-rate payment, or
  • upon paying 30% or 50% of the financing limit, or
  • upon paying the full price - for medications which are not included in the register of reimbursed medications or for medications which are prescribed in an indication which is not subject to reimbursement.

 

If ordered by a health insurance doctor, patients are eligible for free medical transport, including by air, to and from the nearest hospital which provides relevant services if it is necessary to start immediate treatment or to preserve the continuity of treatment, as well as in the case of reduced mobility which makes it impossible to use public transport to travel for treatment (to and from the nearest health care facility which provides relevant services). In other situations, transport is provided for a full or partial payment and based on an order from a health insurance doctor.

Computerisation of the health care system

The health care system in Poland is undergoing dynamic computerisation, giving patients access to new modern e-health services. Beginning in December 2018, Polish doctors issue sick leave certificates in an electronic form only, and beginning on 8 January 2020, prescriptions must be issued electronically (unless required otherwise). The next stage of computerisation of the health care sector will involve, beginning on 8 January 2021, the obligation to issue electronic referrals to certain health care services.

Full use of e-health advantages is possible upon activation of the Online Patient Account, a free-of-charge web application provided by the Ministry of Health which enables patients to easily, quickly and safely view their medical treatment information, including e-prescriptions and dosage instructions issued, e-referrals and electronic sick leave certificates. With the application, patients can also receive e-prescriptions in text messages (SMS) or by e-mail.


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