Article 17
The right to health care included in basic health insurance referred to in Article 15, paragraph 1 hereof shall be ensured for all insured persons of the Institute under equal conditions.
Unless otherwise established by a special act, the Institute shall ensure the payment of health care services to insured persons of the Institute in exercising their rights to health care from basic health insurance established by the health care measure programme referred to in Article 15, paragraph 3 hereof:
1. Complete coverage for:
- preventive health care for children, school children and full-time university students, and adults except for preventive medical examinations that are ensured by the employers or local and regional self-government units based on the law and other administrative provisions;
- curative care and medical rehabilitation for children, pupils and full-time university students;
- orthopaedic and other aids for children up to 18 years of age, pursuant to the by-law of the Institute;
- preventive and curative care services for adults at the level of primary health care other than those established by items 2 – 6 hereof,
- preventive and curative care for women relating to family planning, pregnancy and childbirth monitoring;
- preventive and curative dental care for children up to 18 years of age and pregnant women;
- preventive and curative care relating to HIV infections and other communicable diseases for which there are legal provisions establishing the implementation of measures in order to prevent the spread of such diseases;
- mandatory vaccination, immmunoprophylaxis and chemoprophylaxis,
- laboratory, radiological and other diagnostic procedures at the level of primary health care;
- medically indispensable hospital care, except for the cost of accommodation and meals referred to in items 3 and 4 hereof;
- the cost of hospital accommodation and meals for the treatment of chronic psychiatric patients;
- chemotherapy and radiotherapy;
- health care relating to organ transplantation;
- urgent medical assistance;
- urgent dental assistance;
- urgent medical transport;
- visits to the patient’s home in the case of acute conditions;
- treatment in the patient’s home;
- health-visitor services;
- ambulance for special categories of patients pursuant to the by-law adopted by the health minister;
- drugs from the list of drugs approved by the Institute when they are used for hospital treatment and medicines that are prescribed in primary health care, except for the medicines referred to in items 3, 5, and 6 hereof;
- health care and medical rehabilitation in the case of an injury at work and occupational disease, including orthopaedic and other aids pursuant to the by-law of the Institute;
- medical care in the patient’s home.
2. A minimum of 85% coverage for:
- specialist services including outpatient hospital care outpatient surgical interventions , except for physical medicine and rehabilitation;
- specialist diagnostic procedures not performed at the primary healthcare level;
- orthopaedic and other aids as established in the by-law of the Institute;
- treatment abroad pursuant to the by-law of the Institute;
- physical medicine and rehabilitation in the patient’s home;
- specialist dental services for adults, namely in periodontics;
- specialist dental services for adults, namely in oral surgery.
3. A minimum of 75% coverage for:
- the cost of hospital accommodation and meals in the treatment of chronically ill patients;
- drugs from the list of pharmaceuticals approved by the Institute that are prescribed in primary health care, except for the pharmaceuticals referred to in items 1, 5, and 6 hereof;
- dental health care in mobile and fixed prosthodontics for persons under 70 years of age.
4. A minimum of 70% coverage for:
- specialist services in physical medicine and rehabilitation;
- the cost of hospital accommodation and meals in the treatment of acute diseases.
5. A minimum of 50% coverage for:
- dental services in mobile and fixed prosthodontics for adults ;
- prescription drugs from the list of pharmaceuticals approved by the Institute that are prescribed in primary health care, except for the pharmaceuticals referred to in items 1, 3, and 6 hereof.
6. A minimum 25% coverage for:
- prescription drugs from the list of pharmaceuticals approved by the Institute that are prescribed in primary health care, except for the pharmaceuticals referred to in items 1, 3, and 5 hereof.
The Institute shall cover the payment for health services referred to in items 2 – 6, paragraph 2 hereof in the amount 5% higher than established therein to all persons insured through the Institute who are blood donors with over 100 donations or organ donors for the benefit of another person insured through the Institute.
The scope of rights to health care under basic health insurance as set out in the health care measure programme on an annual basis shall be established in percentages for items 2 – 6, paragraph 2 hereof by the Government of the Republic of Croatia upon the proposal of the health minister.
The percentages referred to in items 2 – 6, paragraph 2 hereof may differ for particular types of medical services or diseases.
The coverage of medical services provided following methods and procedures not established in this Act, or the by-laws adopted on the basis of this Act shall not be ensured for the insured persons of the Institute within the framework of basic health insurance. The following services shall also be excluded from basic coverage:
- experimental treatment, experimental medical products, aids and medicines under clinical testing;
- cosmetic reconstructive surgery, except in the case of the reconstruction of congenital anomalies, breasts after mastectomy, cosmetic reconstruction after severe injuries,
- treatment of voluntarily acquired sterility;
- surgery treatment of obesity;
- treatment of medical complications that occur as a consequence of using health care outside the basic insurance;
- specialised health care for workers exercised on the basis of a contract between an employer and a medical institution offering labour medicine, or between an employer and a labour medicine specialist having a private practice.