Some patients referred to more and more expensive drugs with co-payments need not despair. Health insurers are reimbursing them thousands of crowns each year because caps protect some patients. Last year, a record number of hundreds of millions of crowns were refunded.
The largest insurer, VZP, reports a significant increase in overpaid clients. So far, it paid out the last year, almost CZK 600 million. “The number of clients who will be refunded overpayments in 2021 increased by seven percent compared to the previous year and grew across all age categories. The repayment of overpayments concerns 534,000 VZP clients, “said VZP spokeswoman Viktoria Plívová.
The amounts paid out are also rising. “In one case, the overpayment amounted to more than CZK 14,000 in a single month. This is the highest amount paid out in the last calendar quarter, which was returned to a client from the Pardubice Region,” said ČPZP spokesperson Elenka Mazurová.
Insurance companies refund overpayments for medicines four times a year, always for each calendar quarter. However, they also register patients to whom no trace is made. “In the first to third quarters, we failed to deliver 9,600 payments totaling four million crowns.
In most cases, the payments failed to be paid to elderly seniors. These clients often do not have a mobile phone; some have only a landline number, which is mostly no longer functional. In 140 cases, the insurance company even found that the policyholder did not even have a valid mailing address.
For seniors over 70 years of age and citizens with a recognized disability in the second or third degree, the protective limit is CZK 500. For children and people over 70 years of age, it is CZK 1,000, and for other citizens, it is CZK 5,000.
For most people, the money will come automatically
Citizens with a recognized disability must apply for the overpayment with their health insurance company and provide proof of their disability. In other cases, insurance companies pay out overpayments automatically. Clients do not have to keep track of the amount of the overpayments themselves.
Health insurers are required by law to monitor the total amount of deductible drug co-payments paid by the insured and assess at quarterly intervals (February, May, August, and November) whether the insured has exceeded the limit and is entitled to reimbursement of the overpayment.
The insurer is entitled to include in the limit the additional payment only for medicines listed in the code of drugs for particular medical purposes. This includes, for example, medication for the treatment of cancer, long-term pain, severe asthma attacks, or severe inflammation.