Do you want to know which optional vaccinations are covered by health insurance companies by law?
This article contains optional vaccination under the conditions established by law.
Act No. 48/1997 Coll., on public health insurance and on the amendment and addition of some related laws, covers, among other things, vaccines against selected disease agents, in the so-called least economically demanding implementation. The least economically demanding option means that a fixed amount is set for payment by the health insurance company for all preparations (in this case, vaccines) that are intended for prevention against one disease, and at the same time at least 1 preparation must be provided, which will be paid in full, i.e. without patient surcharge. The amount of the reimbursement and the name of the fully reimbursed preparation may change depending on the unavailability of one preparation on the Czech market (e.g. due to termination of registration), a price reduction of one of the preparations below the established reimbursement, or, on the contrary, an increase in the price in the public interest (in the case of for a single product that is not replaceable, health insurance companies agree to increase the price in the public interest in order to ensure the availability of either the medicinal product intended for treatment or prevention, etc.).
Optional vaccinations, covered under the Health Insurance Act under specified conditions, are the following:
- against the flu - for insured persons over 65 years of age, for insured persons after splenectomy (removal of the spleen) or after hematopoietic cell transplantation, for insured persons suffering from serious chronic pharmacologically treated diseases of the heart and blood vessels, or respiratory tract, or kidneys or diabetes (diabetes) and insured persons placed in medical facilities of providers of long-term inpatient care or in homes for the elderly, or in homes for persons with disabilities or in homes with a special regime;
- against pneumococcal infections in children , if all doses of the vaccine were applied before the insured's seventh month of age; revaccination carried out before the insured person's fifteenth month of age is also a covered service; a paid service is also vaccination carried out after the expiry of the periods specified in this provision, if the administration of one or more doses of vaccines has been postponed due to the health condition of the insured person;
- vaccination and reimbursement of medicinal products containing vaccines for vaccination of insured persons over the age of 65 against pneumococcal infections ; reimbursed vaccines are approved by the Ministry of Health based on the recommendations of the National Immunization Commission and published in the form of a notice in the Collection of Laws;
- against the human papillomavirus , if the vaccination is started from the age of thirteen to the age of fourteen. As of January 1, 2018, vaccinations are covered for both girls and boys;
- against invasive meningococcal infections, pneumococcal infections, invasive disease caused by the causative agent Haemophilus influenzae type ba against influenza, namely in insured persons with impaired or absent spleen function (hyposplenism or asplenia), insured persons after autologous or allogeneic hematopoietic stem cell transplantation, insured persons with severe primary or secondary immunodeficiencies that require dispensary at a specialized workplace, or in insured persons who have experienced invasive meningococcal or invasive pneumococcal infection.
Vaccination is usually carried out by a general practitioner for adults or a general practitioner for children and adolescents (or a gynecologist - vaccination against human papillomavirus).
If you are interested in any of the above-mentioned vaccinations (they are optional), consult your registering general practitioner. Whether you ask your doctor for vaccination yourself or your doctor recommends vaccination, the procedure is as follows:
Influenza vaccination - if necessary, it is vaccinated every year, taking into account the variability of the flu virus. Vaccination is recommended in the period before the expected occurrence of the flu, i.e. from September to mid-December. One vaccine is always fully covered. The vaccine will be provided by the doctor, and after administration will be reported to the health insurance company together with the performance code. If a vaccine is used, which has a fixed surcharge, the patient will pay it directly at the doctor's office. It is only in such a case that he will not demand the vaccine without a surcharge, to which he is automatically entitled.
In the event that a doctor prescribes a prescription, the medicine will not be reimbursed by the health insurance company, as the reimbursement conditions are determined by the doctor's report, not by the pharmacy. It will not be reimbursed even retroactively at the patient's request, as legal regulations in the Czech Republic do not allow this.
Vaccination against pneumococcal infections in children - they are vaccinated with the partially reimbursed medicinal product PREVENAR 13 or the fully reimbursed medicinal product SYNFLORIX. The doctor will provide the vaccine, he will report the application together with the performance code to the health insurance company. Any additional payment is paid by the legal representative in the doctor's office.
In the event that a doctor prescribes a prescription, the medicine will not be reimbursed by the health insurance company, as the reimbursement conditions are determined by the doctor's report, not by the pharmacy. It will not be reimbursed even retroactively at the patient's request, as legal regulations in the Czech Republic do not allow this.
Vaccination against pneumococcal infections in adults - from September 1, 2017, the medicine PREVENAR 13 is fully covered. The vaccine is administered once, the need for revaccination has not yet been established. The vaccine will be provided by the doctor.
In the event that a doctor prescribes a prescription, the medicine will not be reimbursed by the health insurance company, as the reimbursement conditions are determined by the doctor's report, not by the pharmacy. It will not be reimbursed even retroactively at the patient's request, as legal regulations in the Czech Republic do not allow this.
Vaccination schedule against pneumococcal infections:
| The name of the vaccine | Age at vaccination | Total number of doses | |
| PREVENAR 13 SYNFLORIX | basic vaccination with three doses | infants aged 6 weeks to 6 months | 3 doses of 0.5 ml, with the first dose usually at the 2nd month of age (at the earliest at the age of 6 weeks) and thereafter with an interval of at least 1 month between doses + it is recommended to give the fourth (booster) dose at the age of 11 to 15 months |
| alternative vaccination with two doses | infants aged 6 weeks to 6 months | 2 doses of 0.5 ml, with the first dose at 2 months of age, the second dose 2 months later + it is recommended to give the third (booster) dose at the age of 11 to 15 months | |
| premature babies (before the 37th week of pregnancy) | 3 doses of 0.5 ml, with the first dose usually at the 2nd month of age (at the earliest at the age of 6 weeks) and thereafter with an interval of at least 1 month between doses + it is recommended to give the fourth (booster) dose at the age of 11 to 15 months | ||
| previously unvaccinated infants and children over 7 months of age | infants aged 7 to 11 months | 2 doses of 0.5 ml with an interval of at least 1 month between doses + it is recommended to give the third dose in the 2nd year of life | |
| children aged 12 to 23 months | 2 doses of 0.5 ml with an interval of at least 2 months between doses | ||
| children and adolescents aged 2 to 17 years | 1 separate dose of 0.5 ml | ||
| adults 18 years and older patients | 1 single dose of 0.5 ml, while the need for revaccination with a subsequent dose has not been determined | ||
| special population | individuals with diseases such as sickle cell anemia or HIV infection | 1 dose of 0.5 ml can be given | |
| individuals after hematopoietic stem cell transplantation | 3 doses of 0.5 ml, with the first dose administered 3 to 6 months after the hematopoietic cell transplant and thereafter with an interval of at least 1 month between doses + it is recommended to give the fourth (booster) dose 6 months after the third dose | ||
| PNEUMO 23 (until September 1, 2017) | basic vaccination | 1 dose of 0.5 ml Revaccination is recommended with 1 dose of 0.5 ml every 3 to 5 years for people at high risk of pneumococcal infection |
Vaccination against invasive meningococcal infections, pneumococcal infections, invasive disease caused by the causative agent Haemophilus influenzae type ba against influenza - the procedure is the same as for the previous vaccination, with the fact that the doctor will provide the vaccine, and after administration, report it together with the procedure code to the health insurance company. In the event that a doctor prescribes a prescription, the medicine will not be reimbursed by the health insurance company, as the conditions of reimbursement stipulate a report by a doctor, not by a pharmacy. It will not be reimbursed even retroactively at the patient's request, as legal regulations in the Czech Republic do not allow this.
Vaccination against human papillomavirus - if necessary, vaccination paid for by means of public health insurance begins in the period from the age of thirteen to the age of fourteen. He is vaccinated with CERVARIX, which is free of charge, from 1/5/2018 with GARDASIL (replaced by SILGARD) or GARDASIL 9, which are only partially covered, up to the cost of the least expensive variant, which is set at 1765, CZK 79 for one dose. Surcharges are not fixed, so they can vary. The doctor will inform you about the additional payment. Other vaccines do not have a fixed reimbursement. The vaccine will be provided by the doctor, who after administration will report it to the health insurance company together with the performance code. In the event that a vaccine is used, which has a specified surcharge, the legal representative will pay it directly at the doctor's office. In the event that a doctor prescribes a prescription, the medicine will not be reimbursed by the health insurance company, as the reimbursement conditions are determined by the doctor's report, not by the pharmacy. It will not be reimbursed even retroactively at the patient's request, as legal regulations in the Czech Republic do not allow this.
Vaccination schedule - depends on the age at the time of the 1st dose:
| The name of the vaccine | Age at first dose | Total number of doses |
| CERVARIX | 9 to 14 years | 2 doses, with the 2nd dose given between 5 and 13 months after the first dose |
| from 15 years | 3 doses, with the second dose given one month after the first dose and the third 6 months after the second dose; dosage may be adjusted as needed | |
| GARDASIL | 9 to 13 years | 2 doses, with the second dose administered 6 months after the first dose, if the second dose is administered earlier than 6 months after the first dose, a third dose must always be administered. Alternatively, the vaccine can be given in a three-dose vaccination schedule (0.5 ml at months 0, 2 and 6). The second dose must be given at least 1 month after the first dose and the third dose at least 3 months after the second dose. All 3 doses must be given within one year. |
| from 14 years | 3 doses, with the second dose given at least one month before the first dose and the third at least 3 months after the second dose; all three doses must be given in one year | |
| GARDASIL 9 | 9 to 14 years | 2 doses, with the second dose given 5 to 13 months after the first dose; if the second dose is given earlier than 5 months after the first dose, the third dose should always be given. |
| from 15 years | the product can be administered according to a three-dose schedule (0, 2, 6 months). The second dose should be given at least one month after the first dose and the third dose should be given at least 3 months after the second dose. All 3 doses must be given within 1 year. |
In the event that health reasons do not allow vaccination in the specified age interval, the registering doctor can ask the insurance company for approval of an exception with documented justification.
21/04/2018 (updated 14/06/2018)
M.Sc. Radka Brichcínová
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