Treatment is conducted in two ways:
- stationary health spa treatment (with stay) for 14 days
- outpatient spa treatment (without stay) 10 days, the accomodation can be paid by the insured himself.
The health resort does not provide accomodation for insured persons in the nursing unit.
Approved types of standards by ZZZS
Standard type 1 – inflammatory rheumatic diseases
Standard type 2 – degenerative extra-articular rheumatism
Standard type 3 – conditions after injuries and surgeries on the locomotor system with functional impairment
Standard type 4 – neurological diseases, injuries and diseases of the central and peripheral nervous system, including cerbovascular insults and neuromuscular diseases
Standard type 5 – diseases and conditions after cardiovascular surgery
Standard type 6 – gynecological diseases, conditions after operations on the pelvis, testicles and chest
Standard type 7 – skin diseases
Standard type 9 – respiratory diseases
Who has a right to spa health treatment
Insured persons are entitled to spa health treatment, for whom the appointed doctor or the medical commission of the institution decided that he/she is entitled.
Conditions to be met
In accordance with the Rules of Compulsory Health Insurance, insured persons have the right to spa health treatment if they have a medical condition, defined in Article 45 of the Rules of Compulsory Health Insurance and if the spa health treatment ensures at least one of the following conditions is met:
- significant improvement in health condition for a long time,
- restoration of functional and working abilities,
- preventing disease progression or deteriorating health condition for a long time,
- reducing the frequency of absence from work due to illness or hospital treatment.
It is considered that the spa health treatment is not professionally justified and therefore it is not a right coming from the compulsory insurance, when during the planned spa health treatment the insured person has:
- severe mental or personality disorders that prevent the insured person from participating in the spa health treatment procedure,
- drug addiction and chronic ethylism,
- poorly regulated epilepsy,
- infectious diseases (acute and chronic infectious),
- active and evolutionary forms of pulmonary and extrapulmonary tuberculosis,
- chronic organic diseases in the phase of acute deterioration, which can lead to decompensation of vital organs,
- diabetic ketoacidosis and hyperosmolar syndrome,
- frequent and heavy bleeding,
- cancerous neoplasms that have not been surgically removed or stopped in growth by irradiation,
- senile marasmus and more severe forms of generalized atherosclerosis.
Spa health treatment usually lasts 14 days. Exceptionally, the appointed doctor or medical commission can propose a longer treatment or extend it to 28 days at the suggestion of the spa, if it is expected to significantly improve the success of rehabilitation. Spa health treatment of children usually lasts 21 days. The insured person can excercise the right to spa health treatment due to the same disease or the same condition no more than once every two years, and children no more than once a year, provided, of course, that the insured person meets the above-mentioned conditions for such form of treatment.
Spa health treatment approval procedure
In the case of spa health treatment that is not a continuation of hospital treatment, the personal physician submits a proposal for referral to spa health treatment to the appointed physician of the institution, who is responsible for deciding on referral to spa health treatment in accordance with the Health Care and Health Insurance Act. In the event that it is necessary to continue hospital treatment in the spa, the proposal is made by the physician, who treats the insured person, 5 days prior to discharge. The appointed physician decides on the right to spa health treatment with a written Decision. His decision is assessed by the medical commission on the basis of an appeal, which must be filed within 5 working days of receiving the Decision.
In the case of establishing that the spa health treatment is justified in an individual case, the appointed physician should also define in the Decision the type, form or standard, and duration of the spa health treatment. In addition to the above-mentioned, the appointed physician also decides on the health resort in which the spa health treatment will be performed, taking into account the spa’s qualification for a certain form of treatment and, within this, the wishes of the insured person. The insured person can request treatment in health resort other than specified by the appointed physician, provided that the spa health resort is qualified for the approved services.
If the insured person is unable to go to the spa or the treatment is interrupted due to illness or other justified reasons, the insured person must notify the institution and the spa centre to which he was referred. In justified cases, a person can, with the consent of the appointed physician, excercise the right to spa treatment at a later date, but no later than within 3 months.
Estimated deadline for decision
In accordance with the Health Care and Health Insurance Act, the appointed physician issues a decree on his decision no later than eight days after receiving the request or propoal of the personal physician. The eight-day deadline for the decision also applies to the medical commission in the procedures for deciding on the appeal.