Application of a family member for health insurance


Family members are entitled to healthcare services from the day they are registered for health insurance. Registration of a family member for health insurance is made within 7 days. However, who is considered a family member and is it really necessary to have family ties or is it enough to run a common farm?

Obligation to register for health insurance

Registering a family member for health insurance becomes an obligation that arises if the family member is not subject to the obligation to health insurance on his own account, e.g. as an employee, contractor, person running a non-agricultural business, unemployed, student.

This means that it is not necessary to report to ZUS a person registered as unemployed, but also on maternity or parental leave, receiving an allowance, or a pensioner, because the above-mentioned persons have their own title to health insurance.

A family member is considered to be:

  • own child, spouse's child, adopted child, grandson or a foreign child for whom custody has been established, or a foreign child adopted as part of a foster family or family orphanage, until they turn 18, and if they continue their education in a school, teacher training institution , university or research unit conducting doctoral studies - until the age of 26, and if it has a certificate of significant disability or other conditions treated equally - no age limit;
  • spouse;
  • ascendants (i.e. parents or grandparents) remaining in the same household with the insured person.

To cover a family member with health insurance, it is sufficient for one insured person to register a family member for health insurance.

The employee most often reports his descendant or spouse who is unemployed to health insurance, but apart from these typical cases, there are also less standard situations.

Marriage and registering your spouse's child

There may be a situation where an employee wants to register his spouse's child for health insurance. The fact that it is not the own child of an employee but his spouse does not give reasons that prevent such a report from being made. Within the meaning of the Act, the spouse's child is treated as a family member, so there are no obstacles for an employee to be able to include his spouse's child in health insurance when he or she does not have his / her own social insurance entitlement.

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Application for health insurance of the cohabitant

A person who is entitled to health insurance may not register a person with whom he / she lives in an informal relationship, even despite running a common household, because he / she is not a member of his family within the meaning of the provisions on health insurance.

Since the employee's partner is a non-working person, after registering with the employment office as an unemployed person, he will be subject to health insurance on this account, even if he will not be entitled to unemployment benefit.

Example 1.

The employee is raising his 5-year-old son together with his partner with whom he creates an informal relationship. The employee's partner is not entitled to health insurance. She cannot be reported for health insurance by an employee because she is not considered a family member within the meaning of the health law. On the other hand, the employee should report his son to health insurance, because as his own child he is a family member.

Application of a family member for health insurance

The mere application of a family member to health insurance entitles you to use the services of the state health service under the National Health Fund - state medical clinics and hospitals. Application for a family member for health insurance is free and unlimited. This means that any number of eligible persons can be reported to ZUS, provided that they actually do not have their own insurance title.

Contribution payers for their own insurance, including self-employed persons, should register their family members for health insurance themselves. Other people who do not apply for health insurance on their own - we are talking about employees or contractors, must inform the entity competent to apply for health insurance - the employer or the principal - about family members who should be registered for this insurance. The insured person has 7 days to provide this information to his payer from the date of the occurrence of the circumstances that entitle him to register a family member for health insurance.

Therefore, it is the insured who is obliged to inform the contribution payer about the necessity to register or de-register in the form of an application, and the contribution payer is required to submit an appropriate form of the ZCNA declaration to the Social Insurance Institution ("Reporting data on family members for health insurance purposes").

The application of a family member for health insurance is made by the employee or contractor through his employer or the client. On the other hand, if someone is registered in a poviat labor office, he reports there that a family member is registered for health insurance. It is also done by a person who runs a business.