The bill proposed by the Ministry of Health on 4th March concerning additional health insurance might be misleading for insurers as well as health service providers.
Paweł Kalbarczyk
Chairman of the Health and Accident Insurance Commission of the Polish Insurance Association
According to the bill, all life insurance from among accident insurance and sickness insurance could be offered as health insurance. It means that each accident or sickness policy, even if it has nothing to do with the reimbursement of treatment costs or with organizing medical services, could be treated as health insurance. In the Association’s opinion, the current shape of the bill does not give any chances to properly tell the difference between health insurance and other sickness and accident policies. The definition accepted by the Ministry of Health would cause trouble not only to life insurers in creating their product offer but also to tax authorities, if there were a tax relief, because the explicitness of interpretation is especially crucial for these authorities.
In spite of the fact that the phrase „accident or sickness” in the Insurance Activity Act is used to define a type of life insurance, we arrived at a conclusion that the authors of the bill intend to use “health insurance” exclusively for products which include the reimbursement of treatment costs or access to medical services. Such a solution would trigger a situation in which health insurance would be closer, in its nature, to a property policy rather than to a life policy. Another inaccuracy arises here because, in accordance with the Insurance Activity Act, particular groups of property insurance are called “insurance against accident” and “insurance against sickness”, and the bill calls them “accident insurance” and “sickness insurance”. It should not be surprising that shortly after the publication of the bill opinions that the bill does not allow property insurers to offer health products appeared. The fact that shortly after the publication of the bill there were several mutually exclusive opinions in such an important issue proves that it is difficult to guess the real intentions of the definition authors.
In accordance with the manner of creating good law, it should be precisely defined what additional health insurance is. In the opinion of the Polish Insurance Association, the provision which is to define private health insurance and which is to leave no interpretation doubts should have the following form:
additional health insurance – accident or sickness insurance or insurance against an accident or insurance against sickness whose scope might include providing health care for the insured which is provided or financed by an insurance company on the basis specified in the act and occupational health care benefits and other benefits connected with offering, organizing and providing health care benefits.
This manner of definition ensures clear interpretation which is in accordance with the needs of patients and the health protection market. Such definition also triggers a situation in which health insurance might be offered by life and property insurers.
Giving the National Health Fund the possibility to supervise all health service providers, including private and public ones, raises doubts of the Polish Insurance Association. The idea of the act should be to eliminate barriers in contracting by public insurers those health service providers whose equipment and personnel are not fully used. Meanwhile, the bill gives the National Health Fund instruments which trigger a situation in which the state payer will be both the competitor of insurers and the inspector of the agreements between insurers and health service providers.
In the opinion of the Polish Insurance Association, the intention of introducing such solutions by the Ministry of Health was to ensure that patients who do not have private insurance have safe access to benefits financed from public funds. This idea is completely supported by the Polish Insurance Association but the provisions of the act which, according to the authors’ intention, are to protect the rights of patients, have too far-reaching consequences. At the same time, the Association wishes to emphasize that it supports the solutions which allows for no limitation of access to benefits for persons who do not use private insurance. The Polish Insurance Association hopes that the arguments relating to the need to clarify the definition of private health insurance and to change the relations between the National Health Fund, insurers and service providers will be supported by the Ministry of Finance, the Polish Financial Supervision Authority and numerous social partners who see the need to introduce a good act on additional health insurance in the same way as the Polish Insurance Association does.
The Polish Insurance Association believes that the Ministry of Health, as part of public consultation, will take into account the above arguments and will make necessary changes to the bill. The goal of the act is clear for all parties – the reform of the health care system which abolishes limiting medical services for millions of Poles.
