Persons entitled to use healthcare services

Who is entitled to use healthcare services based on health insurance?

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• Persons subject to obligatory health insurance, who are listed in Article 66 of the Act. They include, inter alia, employees employed based on employment contracts, persons carrying out business activities, persons employed based on agency agreements, personal service contracts or other contracts for services governed by provisions of the Civil Code pertaining to personal services

Since Article 66 of the Healthcare Act also applies to foreigners, they are subject to obligatory health insurance on the same principles as Polish citizens if they work legally on the territory of Poland on the aforementioned basis.
To fulfil the insurance obligation, a foreigners needs to be registered with the National Health Fund and pay the premiums. These activities are taken by the remitter of health insurance premium, i.e. usually a Polish employer. A foreigner, who carries out independent business activities, registers for health insurance on his/her own. Any registration and updates are made through the Social Insurance Institution (ZUS) that transfers the information received to the National Health Fund.

• Persons, who signed with the National Health Fund the agreement for voluntary health insurance.

• Family members of the aforementioned persons registered for health insurance, who do not have any other title to this insurance.

In this case, too, family members are registered for insurance by the remitter.
As a result of such registration, family members acquire the right to healthcare services on the same principles and within the same scope as the foreigner insured. Such registration does not necessarily involve paying an additional premium.

The following persons have a status of a family member:

• Child (own, of a spouse, adopted, grandchild, child for whom the insured is a legal guardian or foster parent) until the child attains 18 years of age and if the child continues education – until 26 years of age. A child with the decision confirming significant disability (or other equivalent) can be registered for insurance without age limitation.Grandchildren can be registered only when none of parents is subject to obligatory health insurance or is a person entitled to use healthcare services based on regulations on the coordination due to work performed, work on own account or voluntary insurance.
• Spouse.
• Parents, grandparents living in the same household with the insured.

Subject to exceptions, registration of family members, who do not have any other title to this insurance, for health insurance is obligatory.

However, it does not apply e.g. to foreigners subject to voluntary insurance – students and Ph.D. students and graduates on obligatory traineeship, adaptation traineeship, Polish language course or preparatory courses to start learning in Polish in Poland.

A person insured, in the case of whom the title to be covered by health insurance expired, is deregistered from insurance together with his/her family members. Deregistration is made by the entity responsible for registration.

A family member can lose the right to be covered by health insurance as a result of acquiring own insurance title, e.g. taking up work in Poland or EU/EFTA states, starting own business activities, registration as an unemployed at the Labour Office, graduating a secondary school or university or being deleted from the list of students after attaining 18 years of age.

Lack of registration for or deregistration from health insurance of a family member, or lack of notification to the employer of such need is subject to the penalty of a fine.

• Unemployed persons registered with the labour office.

• Persons entitled to service based on regulations on the coordination, i.e. insured in a Member State of the European Union or the European Free Trade Association (EFTA), residing on the territory of Poland.

Polish regulations on healthcare are supplemented with international law acts on the coordination of social insurance systems. The coordination of insurance systems of the states that are the parties to agreement is aimed at protecting interests of persons moving in order to take up work and employed for certain periods on territories of various states. Regulations on the coordination guarantee, inter alia, that benefits acquired in one state, e.g. old-age pension will be paid also when the entitled person moves to another state. Within the EU, social insurance systems are coordinated by legal regulations on the level of Regulations of the Parliament and of the Council. At the same time, in relationships with other states, these matters are governed by ratified bilateral agreements on social insurance.

• Persons other than insured, who acquired, in Poland:

- the status of refugees,
- supplementary protection,
- permit for temporary residence granted in relation to circumstances referred to in Article 159 section 1 point 1 letter c or d of the Act of 12 December 2013 on foreigners.

• Holders of the Polish Card (Karta Polaka) with respect to using healthcare services in emergency, unless the international agreement concluded by Poland provides for more favourable principles.