Tuesday, 24 October 2017

The business of expat insurance

By Emily Prucha | Prague Daily Monitor |
9 April 2010

Having appropriate medical insurance is a pressing concern for those of us who live abroad. No one wants to end up hospitalized in a foreign country amassing large out-of-pocket bills for medical care. The Czech Republic by law requires foreigners to have medical insurance for the duration of their stay in the country. Issuance of temporary and long-term visas is contingent upon having health insurance that meets the approval of the Czech foreign police. However obtaining Czech insurance isn't the most straight-forward business, nor is finding medical personnel willing to accept the limited versions of Czech insurance that the state issues to foreigners.

Although I now have Všeobecna Zdravotní Pojištovna (VZP) coverage of the same quality as a Czech citizen by virtue of my marriage to Radek, I remember standing in line at the state insurance branch office near Národní třída soon after my arrival in 2002 and trying to sort my way through the insurance puzzle. At the time, it was particularly frustrating that all the forms I had to complete were in Czech and no one in the office spoke English. Nor did any of the other foreigners on my program know any more than I did about how to proceed. However, I muddled my way through and proudly came away with a short-term commercial insurance policy that matched the limits of the one-year working visa I was also in the process of applying for. A Prague TV article published in 2003 provides a still accurate guide for foreigners purchasing VZP insurance. If I could have read it in 2002, I might have saved myself a few headaches.

Still, even though I held a VZP insurance card, most of the Czech doctors I saw gave my card a funny look and told me it wasn't the same as having "real" insurance. The doctors who agreed to take me as a patient often required a co-pay, ranging from CZK 500-1500, depending on the type of visit. Frustrated, I went to the well-known foreigner's department at the Motol hospital complex where I found a staff that spoke decent English, but there I was also required to pay extra for processing lab work. I even tried the Canadian Medical Center where my insurance card was rejected, though my co-pay of CZK 800 didn't seem that out of line with the sums I'd been paying the Czech state system, even with my insurance. Looking back, none of the costs I incurred seemed unreasonable given my comparisons with standard co-payments in the US. However, I wasn't sure why I needed the insurance (beyond the obvious fact that that it was required by law) since it hadn't seemed to save me money or provide me with care that I couldn't get otherwise.

Years later, my experience with VZP health insurance as the wife of a Czech and as a mother to two Czech children has been a positive one. Overall, our family has been provided with excellent health care at minimal cost. Since our first daughter was born in the US, we had a barometer for comparing maternity care and delivery costs when I became pregnant with Oliver after we moved back to Prague. Although Anna Lee's delivery was smooth and our stay at the hospital's birthing center was short, we ended up paying about USD 1,200 for routine hospital costs, compared to receiving an almost comparable sum of money from the Czech government CZK 20 000 upon delivering Oliver. Additionally, when it became necessary for me to undergo an emergency appendectomy during my 34th week of pregnancy with Oliver, I had the operation in the Krč hospital in Prague and paid nothing extra for the operation or my subsequent hospital stay. I did pay out-of-pocket for "above-standard" maternity care so that I could see an English-speaking doctor who agreed to deliver the baby. However, that was my choice, and I have several non-Czech friends married to Czechs who received all their maternity care free on the basis of their VZP insurance.

Since my medical care in the Czech Republic no longer involves worrying about which doctor will accept my insurance or whether I'll have to pay extra, I'd all but forgotten my initial insurance stress until the other day when I was chatting with an American friend who'd just delivered her first child. Over coffee with another friend she gave us the details of her baby's recent delivery in a Prague hospital and we quizzed her with all the usual new-mom questions. Almost as after afterthought, she mentioned, "Oh, and can you believe that the baby isn't insured?" All conversation stopped, "Is it possible that you misunderstood the regulations?" I offered. For a mother with an uninsured child, my friend seemed remarkably calm. But she explained her predicament.

Although she had worked for an international firm and had full VZP coverage throughout her maternity and for the baby's delivery, because my friend wasn't an EU citizen, she was not eligible to automatically add her child to her full-coverage VZP policy. Her husband is Slovak and had he had Czech insurance, there wouldn't have been an issue with insuring the baby. However, because he owns his own firm, which has its seat in Slovakia, he has Slovak insurance, which makes it impossible for the child to get insured in the Czech Republic automatically under her father. The baby is eligible for commercial VZP insurance, but it is the same limited coverage offered to foreigners that covers merely emergencies, not long-term conditions. Had my friend realized the situation in advance, she and her husband could have been more proactive in resolving the matter, but now they can only wait for the baby to be registered in Slovakia as a Slovak citizen so that she can be insured under her father's Slovak coverage. They have been informed that verifying the baby's Slovak citizenship could take 1-3 months.

All in all, my friend and her husband were particularly glad that they hadn't known their daughter's insurance problem at the time of the birth, which would have only added stress to the situation. They were just stunned that an EU baby that was issued a certificate of Czech birth couldn't be fully insured by the Czech system.

For me, particularly having experienced the benefits of the Czech state healthcare system for mothers and young children, I was in disbelief. Yet I've recently heard a few surprising stories from other non-Czech friends about their hassles getting insurance for their children born in the Czech Republic. For example, one Canadian friend was advised by her Czech OBGYN to travel back to Canada to give birth to her child after the doctor diagnosed a pregnancy complication that could result in a pre-term delivery. Since the child would not be automatically covered by the Czech state insurance system at birth and the doctor anticipated the baby's early arrival would require time in an incubator, as well as other potentially costly care, she strongly recommended delivery in the mother's home country where the child could be insured through the mother's status as a permanent resident. The mother did as recommended and her baby received special care covered by Canadian insurance before the family returned to Prague. It's hard to imagine what the best solution for an American would have been in this situation, however.

I ran across another account of foreigners in the Czech Republic being offered limited insurance that directly affected the status of a newborn child. Unfortunately, in this case the Vietnamese parents and their newborn child Do didn't fare as well as my friends, whose healthy newborn child makes the insurance situation only an annoyance and a worry, but not a life changing problem. Do, however, was born months premature and incurred sizable hospital bills without being insured as his parents had not yet achieved permanent residence status. Despite several failed attempts to secure help from the state insurance company early on, Do's tragic situation eventually drew public attention and united several non-profits and insurance companies to donate money to cover his hospital bills. Eventually Do's father received his permanent residence status and Do was offered coverage. Although plans were made to amend the Czech law to comply with EU regulations protecting children from discrimination on the basis of their origin or health condition, it did not force VZP to automatically insure children born to foreigners if their parents are not permanent residents at the time of a child's birth.

Yet most of the insurance situations I've heard about have been resolved without much difficulty or significant financial costs. Another Canadian friend gave birth to her son in Prague and had to wait three weeks after his birth before he was covered under her family's VZP insurance plan, since changes to the plan could be made only at the start of a month. Although his mother knew the baby would be born in January, the insurance company wouldn't let her pre-purchase insurance coverage in December or at the start of January. Instead they required her to wait to submit paperwork after the baby's birth. Although my friends were nervous knowing that their baby would arrive without insurance, when they tried to question the insurance officials, they were treated as if they were the only people who'd ever raised a fuss about such a minor predicament. In the end, my friends didn't have a choice but to bide their time waiting and hope for the best. In this case, the parents didn't incur any costs, just the anxiety of waiting and hoping there wouldn't be any unforeseen complications.

I am reluctant to criticize the Czech healthcare system, particularly when it seems to provide adequate healthcare for its citizens and the majority of foreigners who live here. However, no system is perfect, and it seems that a loophole for newborns, and perhaps for other foreigner statuses as well, exists and could be improved upon. With America on the verge of her own comprehensive healthcare make-over, I'm curious to see how the benefits, services and costs match up with those in place in the Czech Republic in a few years.

Emily Prucha is a Life Section columnist for the Monitor. She likes writing about bilingual and multicultural families.
You can reach her at emily@praguemonitor.com. You can read more of her stories here.