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Proceedings regarding regressive compensations in health insurance
KOHOUTOVÁ, Petra
This bachelor thesis concerns proceedings dealing with regressive compensations in health insurance, that is guided by law No. 187/2006 Coll. about health insurance. The regressive compensation as such takes place when a certain person causes, by his or hers unlawful action, as found by court or other authority, a reason for amount of compensation to another person and is obliged to reimburse the health insurance institution by a prescribed amount. Most often this is a result of traffic accidents, less frequently as a result of physical attacks or fights. The amount that is prescribed as a reimbursement is determined by the actual compensation paid. Together with proceedings about being ordered to pay this regressive compensation, there are other preceedings also concerning regressive compensations, such as pardoning of this regressive payment in which it has been decide for the benefit of concerned person only for reasons defined by law, such as immediate danger of his malnourishment. Also, the proceedings may start about the person being allowed to pay by instalments. This may permit the person to pay a certain amounts at certain conditions as prescribed by the decision. The law also permits cancellation of this insatllment payments option, when the agreed upon conditions are not met. This is a relatively new system that is relatively welcomed by the organs of health insurance, mainly because of the recovery of a certain amount that had been previously wrongly paid. This work is divided into five chapters, dealing with individual components concerning regressive compensation and their relevant proceedings. The first chapter of this work is focused on general information cocerning health insurance. It is divided at several subchapters, dealing with law status, basic principles, subjects of health insurance, group of insured persons, institutional security and a very important subchapter, which is important just for determination of regressive compensations, such as the amount of health insurance and tied to it, the health status determined by an involved physician or medical adjudicating comission. The second chapter deals with proceedings about regressive compensations in health insurance, description of its various stages, such as the commencement, pausing and stopping of the procedure, including the issuance of the decisision and eventual appelation. Included is also a basic information about the pinciples and subjects of these proceedings. Tied to this are the relevant rules and processes that are part of lawful relationships in health insurance, being governed by law No. 500/2005 Coll. about administrative rule, unless set by later rules No. 187/2006 Coll. about health insurance, otherwise. The result of these proceedings is the issuance of the decision, including the entitlement and the amount. The third chapter analyses various types of regressive compensations, such as the pardoning of the regressive compensation, allowing to pay by installments and cancellation of this option. The fourth chapter gives the statistical survey about the development of regressive compensations since their establishment on Jannuary 1, 2009, when the determination § 126 was created. Statistical tables show numerical data about the number of issued decisions and the amounts of compensations in each individual year. The fifth and final chapter contains the closing comments on the topic and suggests possible improvements of practical usage. The aim of this thesis is the analysis and the clearest possible description and definition of the valid law modification, focused on regressive compensations in health insurance, so that it, together with the literature cited, could serve as a source of information, or improve the orientation of eventual direct or indirect participants of these proceedings.
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