Confirmation of the right to NFZ benefits

;A person who intends to use health care services under the National Health Fund (polish “Narodowy Fundusz Zdrowia” shoretend to “NFZ”) insurance is required to provide confirmation of the right to obtain them.

The obligation to present the confirmation of entitlement to benefits does not apply to children up to 6 months of age who have not been registered for health insurance, e.g. due to the lack of a PESEL number.

Until the Health Insurance Card is issued, the document confirming the right to benefits is any document that confirms the entitlement to healthcare services, in particular a document confirming the payment of health insurance contributions, e.g. :

FOR PERSONS EMPLOYED ON THE BASIS OF AN EMPLOYMENT CONTRACT

  • health insurance application form and the currently confirmed monthly ZUS RMUA report issued by the employer (does not apply to people on unpaid leave over 30 days),
  • current certificate from the workplace,
  • insurance card with the current entry and the employer’s stamp;

FOR PERSONS RUNNING AN ECONOMIC ACTIVITY

  • form of the application for health insurance and valid proof of payment of the health insurance premium;

FOR PERSONS INSURED WITH KRUS

  • certificate or ID currently stamped by KRUS (proof of payment of the premium in the case of running special departments of agricultural production);

FOR OLD-AGE AND DISABILITY PENSIONERS

  • pensioner card. In the case of an ID card issued by ZUS, the ID number should be the designation of the NFZ branch.
  • If the 3rd and 4th items of the number contain the character “-“, then the ID card is not a document confirming entitlement to health services. In this case, you must provide another proof of insurance. For example, a person receiving a ZUS pension, but residing in another country, should present a valid EHIC card;
  • certificate from ZUS or KRUS (WBA, ZER MSWiA.),
  • a document confirming the amount of transferred pension;

FOR UNEMPLOYED PERSONS

  • valid certificate from the labor office on the application for health insurance;

FOR THE PERSONS INSURED VOLUNTARY

  • an agreement concluded with the National Health Fund (NFZ) and document from Social Insurance Institution (ZUS)  confirming application for health insurance together with a valid proof of payment for the health insurance premium;

FOR A FAMILY MEMBERS OF THE INSURED PERSONS

  • proof of payment for the health insurance contribution by the person who registered family members for health insurance together with a photocopy of the application (forms: both ZUS RMUA and ZUS ZCNA form if the application was made after July 1, 2008; only ZUS ZCZA if the application was made before July 1 2008),
  • valid certificate issued by the employer, > certificate from KRUS on insurance of family members, > family card with the data of family members, current date and stamp from the workplace or the Social Insurance Institution (ZUS),
  • pensioner card with registered family members subject to insurance, confirming the registration on (or after) 1 January 1999, along with the current benefit payment slip – applies only to KRUS,
  • in the case of children in education – between age of 18 and 26 – additionally, a document confirming the fact of continuing education should be presented – school / student ID or a document confirming a significant degree of disability,
  • in the case of students at age of 26 or beyond – application for insurance by the university (ZUS ZZA form) and a student or doctoral ID card;

FOR UNINSURED PERSONS FULFILLING THE INCOME CRITERION ELIGIBLE TO RECEIVE SOCIAL ASSISTANCE BENEFITS

  • decision of the commune head (mayor, president) competent for the place of residence of that person;

FOR PERSONS INSURED IN A MEMBER STATE OF THE EUROPEAN UNION OR A EUROPEAN FREEDOM TRADE AGREEMENT, OTHER THAN POLAND

  • a certificate issued by the National Health Fund (NFZ) (in the case of living in the territory of the Republic of Poland), > EHIC card (or a certificate replacing it) issued by an EU or EFTA member state other than Poland;

FOR PERSONS ON A CONTINUOUS DOCTOR LEAVE

  • certificates from ZUS informing about the continuity of the exemption. Such persons are entitled to benefits until the last day of their leave;

If the patient does not have a valid certificate confirming the right to benefits, he / she may present such a document at a different time: if he / she is in hospital – not later than within 30 days from the date of admission or within 7 days from the date of termination of the service.

Failure to deliver the document within the aforementioned deadlines may result in the patient being charged with the costs of the service provided! If there is a significant delay in providing confirmation of entitlement to benefits, the service provider may refuse to reimburse you. The above rules also apply to citizens of other EU or EFTA countries entitled to benefits under the provisions on coordination.

VALIDITY OF THE DOCUMENT CONFIRMING THE RIGHT TO BENEFITS

IT IS AGREED THAT THE DOCUMENT CONFIRMING THE RIGHT TO BENEFITS IS VALID FOR 30 DAYS FROM:

  • date of issue – certificate from the workplace, ZUS and KRUS certificates,
  • date of certification – insurance card,
  • premium payment dates – ZUS RMUA, proof of payment for the health insurance premium,
  • expiry date of the document – pensioner card.

THE EXCEPTIONS TO THIS RULE ARE:

  • pensioner ID – valid indefinitely,
  • certificate from the labor office about the application for health insurance – until the expiry date,
  • decision of the commune head (mayor, president)- valid for 90 days from the date specified in the decision.

END OF RIGHTS TO BENEFITS

THE RIGHT TO HEALTHCARE BENEFITS USUALLY ENDS AFTER 30 DAYS FROM THE EXPIRATION OF THE OBLIGATION OF HEALTH INSURANCE, FOR EXAMPLE:

  • in the event of termination of employment (e.g. under an employment contract) – after 30 days from the date of termination of the employment contract,
  • in the event of termination of non-agricultural business activity – after 30 days from the date of termination of such activity,
  • in the case of employees who are on unpaid leave – after 30 days from the date of commencement of the leave,> in the case of unemployed persons – after 30 days from the date of losing the unemployed status,
  • in the event of the death of the person who registered family members for insurance – family members lose the right to benefits after 30 days from the date of death.

PERSONS WHO:

  • have graduated from high school or university or have been removed from the list of pupils or students – the right to healthcare benefits is valid for 4 months after graduation or removal from the list of pupils or students,
  • are applying for an old-age or disability pension – the right to healthcare benefits is granted during the course of the procedure for granting these benefits,
  • receive an allowance granted on the basis of the provisions on sickness or accident insurance – the right to healthcare benefits is granted during the period when these people receive the allowance,

After this time, a person who wants to continue using health benefits under the NFZ insurance should insure themself through another law e.g. voluntarily take out insurance. If it fails to do so, it may bear the costs of the content provided to it.