The new mandatory insurance rules give patients more rights


The introduction of new mandatory health insurance rules brings patients a wider range of rights to certain medical devices, on the other hand, less administration, especially for family doctors and pediatricians. Most of the additional gadgets identified in the 10 million-dollar rule amendment will be available to patients from June.

According to the Director General of the Health Insurance Institute of Slovenia (ZZZS)

, the amendment to the rules of compulsory health insurance, which came into force on 8 February

Marjana Sušlja is financially demanding. As he pointed out at today's press conference, its content focuses primarily on two areas, namely the extension of the rights of insured persons, especially in the field of medical devices, and the second part, administrative burdens.

With regard to the rights of insured persons, Sušelj emphasized the extension of rights in the field of incontinence. “Incontinence policyholders are given an extra diaper a day, from the previous three to four. Those with the most severe incontinence, however, are entitled to two extra diapers, “ he explained.

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“Today, more than 80. 000 insured persons receive at least one device from the incontinence group, ” added Drago Perkič, Head of the Medical Devices Division at the Health Insurance Institute . According to him, the right for these patients is being extended to mobile panties. “These make it easier to care for people with incontinence, especially when it comes to the elderly with dementia,” said and explained that the insured would be able to

According to Sušelj, another important strand of expansion is in the field of diabetes treatment. “We are some kind of pioneers here. Namely, we are introducing a new modern sensor system for the individual patient, which will monitor blood glucose levels. It is an electronic device that monitors all fluctuations and then provides the patient and the doctor with the basis for appropriate action, “ he said.

Each diabetic patient has been stabbed to the tip of his fingers approximately 250 twice a month at the current treatment modality, and most of these stitches are, according to Sušelj, with a new one.

Among other things, Perkic emphasized the expansion of rights for the blind and visually impaired. So far, these have been entitled to the Braille machine or the Braille bar, and with the amendment of the rules, these two gadgets will no longer be mutually exclusive. All of these rights will otherwise come into effect on June 1 due to financial consequences.

In simplifying the enforcement procedures, the Director-General highlighted the issue of referrals as the most important novelty. “A referral for a specialist visit is provided by a family doctor. So far, if the deadline has expired, patients have to go to the family doctor again, and the new rules allow the specialist to extend the referral for up to two years, as appropriate, ” said.

Director of the medical device rights decision-making field Ana Vodičar also cited alleviation as a novelty restrictions on dispensing expensive drugs medicines whose packaging price exceeds 200 EUR. Previously, a doctor could prescribe an annual renewable prescription, but he only took the medicine to the pharmacy for one month. “He will also be able to take medicines at the pharmacy for up to three months at the pharmacy. This innovation will be most important for HIV patients, for the treatment of hepatitis, multiple sclerosis, as well as for certain biological rheumatic drugs, ” summed up Vodichar's.

The HIIS also introduced t. i. electronic sick leave. For sick leave from February 1, all employers and insured persons who are self-payers and are registered in the Business Register can receive certificates of justified work retention through the Business Support Information System.

Insured persons are no longer required to physically bring their certificates to the employer, nor is it necessary to visit a personal physician only for the purpose of issuing a certificate at the end of the sick leave, if the expert assesses that a personal examination is not necessary. In doing so, the HIIS simplifies the procedure for exercising the right to remuneration for both insured persons and employers, while relieving family doctors and pediatricians.