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Reading health contract fine print

Cristina, a 31 year-old Romanian sales executive living in Bratislava, was flabbergasted last month when her private health insurance company said she would have to pay higher premiums because she had developed ovarian cysts.
Although Cristina had a note from her doctor saying she would require no operation or special treament for her ailment, a health insurance agent with Vzájomná Životná Poisťovňa (VŽP) said she had become a 'risky' client, and would have to fork out another 700 Slovak crowns monthly ($17) on top of the 1,700 crowns she had been paying for over a year.
Furious, she decided not to renew her contract with VŽP, the only health insurance company in Slovakia that provides commercial health insurance to foreigners who don't have residence permits or green cards.


VZP Director Róbert Kubinsky.
photo: Courtesy VZP

Cristina, a 31 year-old Romanian sales executive living in Bratislava, was flabbergasted last month when her private health insurance company said she would have to pay higher premiums because she had developed ovarian cysts.

Although Cristina had a note from her doctor saying she would require no operation or special treament for her ailment, a health insurance agent with Vzájomná Životná Poisťovňa (VŽP) said she had become a 'risky' client, and would have to fork out another 700 Slovak crowns monthly ($17) on top of the 1,700 crowns she had been paying for over a year.

Furious, she decided not to renew her contract with VŽP, the only health insurance company in Slovakia that provides commercial health insurance to foreigners who don't have residence permits or green cards.

"It wasn't fair of them [VŽP] because my health condition hasn't really changed," Cristina said, adding that VŽP had decided to put her into the more expensive category on the basis of advice from their own physician - who had never examined her.

For many foreigners living in Slovakia - students, long-term visitors or unofficial workers - VŽP is the only place they can get insured. According to legal experts and Health Ministry officials, these people have little choice but to abide by the terms of the contract VŽP offers, however unfair they may feel it to be.

VŽP Director Róbert Kubinský said that as a private commercial insurance company, VŽP sets its payment policy and client categorizations as it sees fit. The terms are included in the General Policy Conditions, a document which clients read before signing a contract. "It's then up to the client to choose whether he accepts our conditions or not," Kubinský said.

VŽP takes three criteria into account when setting insurance rates - the age of the client, the state of the client's health, and the length and type of insurance requested. A 35 year-old foreigner in good health and with no history of chronic disease pays the basic 1,620 Slovak crowns per month, which includes preventive and curative care, medicine and medical aids, out-patient and in-patient treatment and dental care.

Problems may arise, however, when clients seek coverage for an operation or hospital stay, because VŽP may decide that their illness was caused by a "pre-existing condition," meaning that treatment isn't covered if the client didn't declare the condition beforehand. In such cases, it makes no difference whether the client did or did not know of his health condition.

"Our policy is unambiguous. If a client tries to mislead us, we strongly defend our interests," Kubinský said.

Kubinský explained that VŽP's in-house physician - the "revision doctor" - has the decisive say on the rates which clients pay. "Although we take into consideration doctors' notes on their clients' health, the decision of our revision doctor is final," Kubinský said. "If a client doesn't purposely hide his state of health, and if he informs us [the insurance company] of it properly, then all expenses are covered by the insurance company, no matter how high they are."

However, one legal expert said that clients would have a hard time getting their money back if they felt VŽP had ruled unfairly. "If the insurance company doesn't want to pay the expenses of its clients' health care, he has little room to manoeuver," said Bratislava lawyer Ernest Valko, former chief justice of the Czechoslovak Constitutional Court. "The only way the client can get redress from the insurance company is through the court," continued Valko, adding that this was a complicated procedure, as a special team of doctors had to examine the client's state of health and then decide whether the revision doctor had made the right decision.

Valko stressed, however, that the revision doctor could not make a decision on a client's state of health without examining the person. "Each client ought to insist on this," Valko said.

Kubinský agreed with Valko that when challenged, VŽP had the upper hand on clients. "We can develop efficient pressure to defend our interests through legal means, that's for sure," Kubinský said.

Government officials also said there was nothing the state could do to help a client who disagreed with the terms of his VŽP contract. Eva Bónová, the head of the Finance Ministry's watchdog branch, explained that "these [private] insurance companies provide clients with commercial insurance, and the law says that the ministry is not obliged to evaluate the pricing policy and wording of the contract in such cases."

Slovakia has 27 private insurance companies, but VZP is the only one offering health insurance to foreigners not insured in the public system. Revenues from foreigners insured last year hit 6.5 million crowns ($158,000), while in the first nine months of 1999 the figure was six million.

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