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Ak chcete zmeniť zdravotnú poisťovňu, máte čas už len do konca mesiaca


 | 19.9.2013 | komentárov: 304

Podľa zákona č. 580/2004 Z. z. o zdravotnom poistení a o zmene a doplnení zákona č. 95/2002 Z. z. o poisťovníctve a o zmene a doplnení niektorých zákonov (ďalej len zákon o zdravotnom poistení) je právom poistenca podať prihlášku v zdravotnej poisťovni, ktorú si vybral. Na podanie prihlášky máte čas do konca mesiaca september.

Zákon o zdravotnom poistení dáva poistencovi možnosť zdravotnú poisťovňu zmeniť. Pre zmenu je potrebné podať prihlášku a to najneskôr do 30. septembra kalendárneho roka. Ak poistenec podá prihlášku včas (do 30. septembra), zdravotná poisťovňa je povinná elektronicky potvrdiť prihlášku do 15. decembra príslušného kalendárneho roka. Poistenec môže zmeniť príslušnú zdravotnú poisťovňu vždy len k 1. januáru nasledujúceho kalendárneho roka, preto ak poistenec podal prihlášku do 30. septembra kalendárneho roka, zdravotná poisťovňa, ktorá prihlášku potvrdila, je jeho príslušnou zdravotnou poisťovňou od 1. januára nasledujúceho kalendárneho roka. Poistenec, ktorý podal prihlášku z dôvodu zmeny zdravotnej poisťovne, je oprávnený vziať späť podanú prihlášku bez uvedenia dôvodu do 30. septembra príslušného kalendárneho roka. Späťvzatie musí byť podané písomne v zdravotnej poisťovni, ktorej bola doručená prihláška. Zdravotná poisťovňa musí žiadateľovi vyhovieť. Ak verejné zdravotné poistenie vzniklo a zaniklo v priebehu toho istého kalendárneho roka musí poistenec podať prihlášku v tej zdravotnej poisťovni, v ktorej bol poistený naposledy.

Prihlášku možno podať len v jednej zdravotnej poisťovni. Ak by poistenec podal prihlášku z dôvodu zmeny zdravotnej poisťovne vo viac ako jednej zdravotnej poisťovni, platí jeho právo späťvzatia prihlášky. Ak nemožno určiť príslušnú zdravotnú poisťovňu poistenca, ktorý podal prihlášku vo viac ako jednej zdravotnej poisťovni, poistenec je povinný do ôsmich dní od preukázateľného doručenia písomnej žiadosti Úradu pre dohľad nad zdravotnou starostlivosťou (ďalej úrad) písomne oznámiť úradu, na ktorej podanej prihláške trvá. Ak si poistenec túto povinnosť nesplní, všetky jeho prihlášky sú neplatné. Príslušná zdravotná poisťovňa je povinná vyžiadať si od zdravotnej poisťovne, ktorá naposledy vykonávala verejné zdravotné poistenie poistenca, údaje z účtu poistenca do dvoch mesiacov odo dňa začatia vykonávania verejného zdravotného poistenia pre poistenca.

Prihláška musí mať písomnú formu a musí obsahovať:

a) označenie, že ide o prihlášku, dátum jej podania a čas,

b) meno, priezvisko, rodné priezvisko, rodné číslo, pohlavie, adresu trvalého pobytu a prechodného pobytu poistenca, dobu trvalého pobytu na území Slovenskej republiky; u cudzinca sa uvádza adresa trvalého pobytu v cudzine a kontaktná adresa, štátna príslušnosť, dátum narodenia, ak mu rodné číslo nebolo pridelené, a číslo identifikačnej karty alebo pasu,

c) v prípadoch osoby, ktorá bola pozbavená spôsobilosti na právne úkony, osoby ktorá je vo väzbe alebo vo výkone trestu odňatia slobody a v prípade maloletého poistenca meno a priezvisko, rodné číslo a adresu trvalého pobytu, ak ide o fyzickú osobu, a názov alebo obchodné meno, sídlo, právnu formu a identifikačné číslo, ak bolo pridelené, ak ide o právnickú osobu,

d) obchodné meno zdravotnej poisťovne, v ktorej sa prihláška podáva,

e) označenie poistenca,

f) označenie platiteľa poistného,

g) podpis poistenca alebo podpis zákonného zástupcu

Okrem toho je poistenec pri zmene zdravotnej poisťovne povinný do ôsmich dní vrátiť preukaz poistenca príslušnej zdravotnej poisťovni. Pre zachovanie lehoty postačuje ak sa preukaz poistenca odovzdá v posledný deň tejto lehoty na poštovú prepravu.
Ak poistenec podal prihlášku po 30. septembri kalendárneho roka, prihláška sa považuje za podanú 1. januára nasledujúceho kalendárneho roka a teda k zmene zdravotnej poisťovne nedochádza.
Za poistenca, ktorý bol pozbavený spôsobilosti na právne úkony podáva prihlášku jeho zákonný zástupca. Za maloletého poistenca je povinný podať prihlášku:

a) zákonný zástupca alebo iná fyzická osoba alebo právnická osoba, ktorej bol maloletý zverený do výchovy,
b) poskytovateľ zdravotnej starostlivosti alebo zariadenie, v ktorom je umiestnený na základe rozhodnutia súdu, ak zákonný zástupca nie je známy a maloletý poistenec je umiestnený v zdravotníckom zariadení ústavnej zdravotnej starostlivosti alebo v zariadení na základe rozhodnutia súdu,
c) poskytovateľ zdravotnej starostlivosti, ak ide o poistenca, ktorého matka písomne požiadala o utajenie svojej osoby v súvislosti s pôrodom.

Ak za maloletého poistenca, ktorého údaje nie sú známe, podáva prihlášku poskytovateľ zdravotnej starostlivosti alebo zariadenie, v ktorom je umiestnený na základe rozhodnutia súdu, prihláška musí obsahovať údaje umožňujúce jeho identifikáciu. Ak prihlášku podáva poskytovateľ zdravotnej starostlivosti za poistenca, ktorého matka písomne požiadala o utajenie svojej osoby v súvislosti s pôrodom, prihláška musí okrem štandardných údajov obsahovať deň, mesiac, rok a miesto narodenia dieťaťa a údaj, že ide o poistenca, ktorého matka požiadala o utajenie svojej osoby v súvislosti s pôrodom. Prihláška pri zmene zdravotnej poisťovne musí obsahovať okrem týchto základných náležitostí aj obchodné meno príslušnej zdravotnej poisťovne poistenca. S požiadavkou na preverenie postupu zdravotnej poisťovne sa poistenec môže obrátiť aj na Úrad pre dohľad nad zdravotnou starostlivosťou. V záujme rýchlejšieho prešetrenia však úrad odporúča poistencom najprv kontaktovať ich novú zdravotnú poisťovňu.

Spracovala: Veronika Miková

zdroje:     zákon č. 580/2004 Z. z. o zdravotnom poistení a o zmene a doplnení zákona č. 95/2002 Z. z. o poisťovníctve a o zmene a doplnení niektorých zákonov
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