Important information for healthcare facilities

The subject of the insurance is the reimbursement of the costs of treatment undergone by the insured in a medical facility in the Czech Republic during his/her stay in the Czech Republic.

This is not public health insurance, but commercial insurance. Therefore, health care facilities do not have the right to demand regulatory fees from the client and it is not possible for the client to be refused treatment by the contracted health care facility.

1. The insured person shall always present his/her identity card and the insured person’s card (if his/her health condition allows it) when visiting a health care facility.

• Check that the identification data of the insured person from the insured person’s card matches the identity card.
• Check the validity of the insurance (insurance period – start and end of the insurance period, waiting period for pregnancy and childbirth).
• Find out the type of insurance and the exact name of the insurance product.

2. Contact the helpdesk. The card gives you the contact details of the helpline you should contact before receiving or using healthcare. The helpline is available 24 hours a day, 7 days a week.

• Assistance service of the VZP Insurance Company, a. s.: + 420 296 841 300

The main reasons to contact the assistance service:

• validation of the licence,
• verification of the scope of the health insurance coverage in relation to the specific health condition of the foreign patient,
• verification of the available balance of the insurance benefit limit,
• guaranteeing reimbursement of health care
• in the case of outpatient treatment, the provision of a payment guarantee for a specific amount

When reporting a claim, please state:

• policy number
• name and surname of the insured
• date of birth of the insured
• sex of the insured person
• a brief description of the event (what happened – mechanism of injury or what disease it is)
• contact details of the insured person’s medical institution and attending physician, or other contact persons

3. IMPORTANT!

All planned interventions must be approved in advance by the VZP, a. s. Insurance Company through the assistance service on the basis of a medical report.
All documents for the assessment of the claim can be sent by e-mail to: pvzp-asistence@eurocross.cz

Assistance service of the Insurance company VZP, a. s.: + 420 296 841 300

4. Submit a bill to the PHP for reimbursement for health services provided if you do not have an electronic bill.

Send all insurance related documents submitted for reimbursement for health care services provided by you (bills, invoices, memory devices, reports, etc.) and all other correspondence to:

Insurance company VZP, a. s.
Lazarská 1718/3
110 00 Prague 1

In the case of electronic communication with Pojišt’ovna VZP, a. s., the maximum allowed size of attachments in an e-mail is 15 MB. In case of larger attachments, the content of the sent documentation must be divided into several e-mails. If the maximum size of attachments is exceeded, the e-mail will not be delivered.

1. If the health care facility or attending physician requires only verbal information as to whether the event is covered by the insurance, he/she will provide the above information to the assistance coordinator, who will verify the validity of the insurance policy and inform the health care facility or attending physician whether the client’s insurance policy is valid, what the client’s insurance policy covers and the general scope of the client’s insurance benefit.
2. If the healthcare facility or treating doctor requires binding information on whether the treatment/treatment/examination will be covered, a medical report must be sent to the assistance service to assess the claim.
3. If the medical facility or the attending physician requires written confirmation of whether and to what extent the insurance covers a specific procedure, examination, etc., a copy of the medical report must be sent to the assistance service. Upon receipt of the documents, the assistance service will assess the claim and inform the healthcare institution or treating doctor in writing.
4. As soon as the assistance service receives all the necessary documents for the assessment of the insured event, it informs the medical facility about the liquidation of the insured event – in case of outpatient treatment/examination usually within 1 working day, in case of hospitalization usually within 3 working days.
5. If the medical facility or the attending physician sends written documents to the assistance service without prior notification of the insurance event by telephone, the assistance service registers the insurance event in the system according to the documents sent, verifies the validity of the insurance contract and subsequently sends the medical facility or the attending physician a confirmation of the validity and type of the client’s insurance contract, confirms receipt of the documents, or sends a request for delivery of documents necessary to assess the liquidity of the insurance event.
6. Provision of a pre-guarantee for the payment of health care: A pre-guarantee is provided by the assistance service for a specific amount for a specific treatment

• The provision of a pre-guarantee is subject to pre-defined conditions such as notification of the treatment to the assistance service, length of insurance, subsequent presentation of a medical report for billing.
• Payment on the basis of the pre-guarantee is made at the contractual prices set out in the cooperation agreement.

All documents for the assessment of the claim can be sent by e-mail to
pvzp-asistence@eurocross.cz 

Contacts for resolving issues related to contracts between medical facilities and the VZP, a. s. Insurance Company:

E-mail: eVyuctovani@pvzp.cz

Inquiries regarding claims reporting:

Assistance service of Pojišt’ovna VZP, a. s.
Tel.: + 420 296 841 300

Other insurance enquiries:

Infoline of Pojišt’ovna VZP, a. s.
Tel.: 233 006 311
E-mail: info@pvzp.cz