Any beneficiary applying for the provision of health care is obliged to present the proof of health insurance. Any document, which confirms payment contributions for health insurance, is the proof of health care services. In case of pensioner and annuitants, it shall be document confirming the transfer of pension, but also pensioner’s card may be treated as the proof confirming payment for health insurance.
In the case of citizens of Poland, other than insured, who have the place of residence on Polish territory, the document confirming health care services is the decision of vogt (mayor or president) of commune competent for the place of residence. Such decision, which is valid within 30 days, has to be delivered to the relevant branch of a National Health Fund. In emergency cases, the document may be submitted in any other time, but no later than within 30 days from the day of providing health services, unless the patient is still in hospital – no later than 7 days from the date of completion of patient treatment. If the case of Failing to present the proper insurance document within the time limits specified by the law, the costs of the treatment are attributed to the beneficiary. Submission of the insurance document later than specified by the law, cannot be used a reason to refuse to wave the payment or reimburse the costs of treatment.
Beneficiary has the right to hospital treatment based on the referral form the physician, dentist or feldsher:
The referral is not required from the specialists listed below:
- gynecologist and obstetrician,
The referral for ambulatory specialized care is not required also from::
- war invalids, repressed people and veterans,
- patients with tuberculosis,
- infected with HIV,
- people addicted to alcohol, drugs and psychotropic substances – in the field of addiction treatment,
- entitled (soldiers or workers) for the treatment of injuries or diseases acquired while performing professional duties outside the country.
The discharge report from former hospitalization or from emergency department is not treated as the referral from the specialist. If the hospital discharge report contains the note of treatment continuation, the referral should be issued by the general practioner.
The referral for specialized treatment at the clinic encompasses all services related to the treatment of particular disease, which was the reason of issuing of the referral.
If the doctor issues the referral, he has to indicate also the place where the particular test and examinations should be done by patient. The doctor in charge should specify the proper entity with which the clinic has signed an agreement of collaboration.
Examinations such as magnetic resonance, computed tomography, gastroscopy, colonoscopy, fetal echocardiography (outpatient cost- consuming diagnostic tests) can be performed in every diagnostic center, which has signed the proper contract with the National Health Fund.
A health insurance doctor is the doctor providing services under the contract with the National Health Fund. He is obliged to use paper defined by the National Health Fund (unless they are results of separate regulation).
During the hospitalization of the beneficiary, the doctor of Primary Care cannot issue the prescription for pharmaceuticals or orthopedic aids, which are indicated as a result of hospitalization, but the physician can issue prescription for pharmaceuticals or orthopedic aids, which indications are not connected with current hospitalization.