{"id":304920,"date":"2024-04-22T11:25:57","date_gmt":"2024-04-22T10:25:57","guid":{"rendered":"https:\/\/zakrasnejsivimperk.cz\/?p=304920"},"modified":"2024-04-22T11:25:57","modified_gmt":"2024-04-22T10:25:57","slug":"vseobecna-zdravotni-pojistovna-uhrada-zubni-nahrady","status":"publish","type":"post","link":"https:\/\/zakrasnejsivimperk.cz\/?p=304920","title":{"rendered":"V\u0160EOBECN\u00c1 ZDRAVOTN\u00cd POJI\u0160\u0164OVNA: \u00dahrada zubn\u00ed n\u00e1hrady"},"content":{"rendered":"

\"\"<\/p>\n

OT\u00c1ZKA:<\/h6>\n
Jak \u010dasto a jak jsou hrazeny zubn\u00ed prot\u00e9zy zdravotn\u00ed poji\u0161\u0165ovnou u dosp\u011bl\u00e9ho poji\u0161t\u011bnce?<\/b><\/h6>\n
ODPOV\u011a\u010e:<\/h6>\n

Stomatologick\u00e9 v\u00fdrobky jsou hrazeny z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed v\u00a0rozsahu a\u00a0za\u00a0podm\u00ednek stanoven\u00fdch v\u00a0z\u00e1kon\u011b o ve\u0159ejn\u00e9m zdravotn\u00edm poji\u0161t\u011bn\u00ed (P\u0159\u00edloha \u010d. 4 z\u00e1kona \u010d.\u00a048\/1997 Sb.).\u00a0Z\u00e1kon\u00a0<\/b>tak\u00e9\u00a0stanovuje, jak\u00e1 je v\u00fd\u0161e \u00fahrady u stomatologick\u00fdch v\u00fdrobk\u016f hrazen\u00fdch \u010d\u00e1ste\u010dn\u011b, tzn.\u00a0se\u00a0spolu\u00fa\u010dast\u00ed ze strany poji\u0161t\u011bnce.<\/b>\u00a0Podm\u00ednky \u00fahrady jsou stejn\u00e9 pro v\u0161echny zdravotn\u00ed poji\u0161\u0165ovny.<\/p>\n

Zubn\u00ed l\u00e9ka\u0159 m\u016f\u017ee dle stavu chrupu poji\u0161t\u011bnce zhotovit celkovou nebo \u010d\u00e1ste\u010dnou sn\u00edmatelnou zubn\u00ed n\u00e1hradu\u00a0<\/b>(prot\u00e9zu). Oba tyto druhy zubn\u00edch sn\u00edmateln\u00fdch n\u00e1hrad jsou z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed dosp\u011bl\u00e9mu poji\u0161t\u011bnci hrazeny 1x\u00a0za\u00a04 roky\u00a0<\/b>(dosp\u011bl\u00fdm je poji\u0161t\u011bnec ode dne dosa\u017een\u00ed v\u011bku 18 let).<\/u><\/p>\n

Celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada u dosp\u011bl\u00e9ho poji\u0161t\u011bnce<\/b><\/h6>\n

P\u0159i \u00fapln\u00e9 ztr\u00e1t\u011b vlastn\u00edho chrupu se pou\u017e\u00edv\u00e1 celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada. Celkovou sn\u00edmatelnou n\u00e1hradu lze zhotovit ve dvou variant\u00e1ch-z\u00e1kladn\u00ed a ostatn\u00ed.<\/b><\/p>\n

Celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada \u2013 z\u00e1kladn\u00ed proveden\u00ed<\/u><\/p>\n

Celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada v z\u00e1kladn\u00edm proveden\u00ed<\/b>\u00a0(prysky\u0159i\u010dn\u00e9 zuby a prysky\u0159i\u010dn\u00e1 baze zubn\u00ed n\u00e1hrady)\u00a0je poji\u0161t\u011bnci z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed pln\u011b hrazena. Spolu\u00fa\u010dast poji\u0161t\u011bnce v\u00a0p\u0159\u00edpad\u011b celkov\u00e9 sn\u00edmateln\u00e9 n\u00e1hrady z\u00e1kladn\u00ed nen\u00ed \u017e\u00e1dn\u00e1.<\/b><\/p>\n

Celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada \u2013 ostatn\u00ed<\/u><\/p>\n

Zubn\u00ed l\u00e9ka\u0159 m\u016f\u017ee poji\u0161t\u011bnci zhotovit tak\u00e9 celkovou sn\u00edmatelnou n\u00e1hradu ostatn\u00ed, kter\u00e1 je\u00a0vyrobena za pou\u017eit\u00ed jin\u00fdch technologick\u00fdch postup\u016f, materi\u00e1l\u016f a konstruk\u010dn\u00edch prvk\u016f<\/b>\u00a0ne\u017e\u00a0celkov\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada z\u00e1kladn\u00ed.\u00a0Zdravotn\u00ed poji\u0161\u0165ovna hrad\u00ed celkovou sn\u00edmatelnou n\u00e1hradu ostatn\u00ed \u010d\u00e1ste\u010dn\u011b. \u010c\u00e1stku do pln\u00e9 ceny n\u00e1hrady dopl\u00e1c\u00ed poji\u0161t\u011bnec.<\/b><\/p>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada u dosp\u011bl\u00e9ho poji\u0161t\u011bnce<\/b><\/h6>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada nahrazuje chyb\u011bj\u00edc\u00ed zuby v\u00a0horn\u00ed \u010di spodn\u00ed \u010delisti (nen\u00ed ur\u010dena pro bezzub\u00e9 \u010delisti). Pou\u017e\u00edv\u00e1 se zpravidla v\u00a0situaci, kdy zb\u00fdvaj\u00edc\u00ed zuby ji\u017e nejsou schopny n\u00e9st pevnou n\u00e1hradu (tzv. m\u016fstek), ale jsou je\u0161t\u011b dostate\u010dn\u011b kvalitn\u00ed, aby tvo\u0159ily oporu pro \u010d\u00e1ste\u010dnou sn\u00edmatelnou n\u00e1hradu. \u010c\u00e1ste\u010dnou sn\u00edmatelnou n\u00e1hradu lze zhotovit ve dvou variant\u00e1ch-z\u00e1kladn\u00ed a ostatn\u00ed.<\/b><\/p>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada \u2013 z\u00e1kladn\u00ed proveden\u00ed<\/u><\/p>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada v\u00a0z\u00e1kladn\u00edm proveden\u00ed<\/b>\u00a0m\u00e1 prysky\u0159i\u010dn\u00e9 t\u011blo se zabudovan\u00fdmi jednoduch\u00fdmi op\u011brn\u00fdmi a reten\u010dn\u00edmi prvky, zaji\u0161\u0165uje sm\u00ed\u0161en\u00fd (dentomuk\u00f3zn\u00ed) p\u0159enos \u017ev\u00fdkac\u00edho tlaku a stabilitu prot\u00e9zy v\u00a0\u00fastech.\u00a0Je pln\u011b hrazena z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed, tj. nen\u00ed \u017e\u00e1dn\u00e1 spolu\u00fa\u010dast ze strany poji\u0161t\u011bnce.<\/b><\/p>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada \u2013 ostatn\u00ed<\/u><\/p>\n

\u010c\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada ostatn\u00ed je vyrobena za pou\u017eit\u00ed jin\u00fdch technologick\u00fdch postup\u016f, materi\u00e1l\u016f a konstruk\u010dn\u00edch prvk\u016f<\/b>\u00a0(nap\u0159\u00edklad kovov\u00e9 spojovac\u00ed t\u0159meny, z\u00e1suvn\u00e9 spoje apod.) ne\u017e \u010d\u00e1ste\u010dn\u00e1 sn\u00edmateln\u00e1 n\u00e1hrada z\u00e1kladn\u00ed.\u00a0\u00dahrada ze\u00a0zdravotn\u00edho poji\u0161t\u011bn\u00ed je\u00a0\u010d\u00e1ste\u010dn\u00e1.<\/b>\u00a0\u010c\u00e1stku do\u00a0pln\u00e9 ceny dopl\u00e1c\u00ed poji\u0161t\u011bnec.<\/b><\/p>\n

Jak m\u00e1m po\u017e\u00e1dat o p\u0159isp\u011bn\u00ed na zubn\u00ed prot\u00e9zu?<\/b><\/h6>\n

Zubn\u00ed n\u00e1hrady jsou stomatologick\u00e9 v\u00fdrobky, kter\u00e9 jsou poji\u0161t\u011bnci hrazeny z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed pln\u011b nebo \u010d\u00e1ste\u010dn\u011b.\u00a0<\/b>Nejedn\u00e1 se\u00a0<\/b>o p\u0159\u00edsp\u011bvek zdravotn\u00ed poji\u0161\u0165ovny poji\u0161t\u011bnci.<\/p>\n

O \u00fahradu z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed poji\u0161t\u011bnec ne\u017e\u00e1d\u00e1. Zdravotn\u00ed poji\u0161\u0165ovna hrad\u00ed \u00fahradu p\u0159\u00edmo poskytovateli zdravotn\u00ed p\u00e9\u010de.\u00a0<\/b>U pln\u011b hrazen\u00fdch variant n\u00e1hrad poji\u0161t\u011bnec nedopl\u00e1c\u00ed \u017e\u00e1dnou \u010d\u00e1stku. U \u010d\u00e1ste\u010dn\u011b hrazen\u00fdch variant dopl\u00e1c\u00ed poji\u0161t\u011bnec rozd\u00edl mezi celkovou cenou n\u00e1hrady a\u00a0\u010d\u00e1stkou, kterou hrad\u00ed zdravotn\u00ed poji\u0161\u0165ovna poskytovateli.<\/p>\n

Podm\u00ednkou \u00fahrady zubn\u00edch n\u00e1hrad z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed je,\u00a0\u017ee n\u00e1hrady mus\u00ed zhotovit smluvn\u00ed poskytovatel zdravotn\u00ed p\u00e9\u010de\u00a0<\/b>(poskytovatel mus\u00ed m\u00edt se\u00a0zdravotn\u00ed poji\u0161\u0165ovnou poji\u0161t\u011bnce uzav\u0159enu smlouvu o\u00a0poskytov\u00e1n\u00ed a\u00a0\u00fahrad\u011b hrazen\u00fdch slu\u017eeb).<\/p>\n

Kdy mohu znovu z\u00edskat \u00fahradu zubn\u00ed n\u00e1hrady ze zdravotn\u00edho poji\u0161t\u011bn\u00ed?<\/b><\/h6>\n

Informace o tom, kdy byla zubn\u00ed n\u00e1hrada naposledy uhrazena ze zdravotn\u00edho poji\u0161t\u011bn\u00ed je uvedena v\u00a0evidenci zdravotn\u00ed poji\u0161\u0165ovny a tak\u00e9 ve\u00a0zdravotnick\u00e9 dokumentaci poji\u0161t\u011bnce. Zubn\u00ed l\u00e9ka\u0159 by m\u011bl poji\u0161t\u011bnce informovat o tom, kdy lze\u00a0dal\u0161\u00ed novou prot\u00e9zu opakovan\u011b hradit z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed.<\/p>\n

Pokud se poji\u0161t\u011bnec zaregistruje u nov\u00e9ho zubn\u00edho l\u00e9ka\u0159e, vy\u017e\u00e1d\u00e1 si nov\u00fd registruj\u00edc\u00ed zubn\u00ed l\u00e9ka\u0159 p\u0159i p\u0159evzet\u00ed poji\u0161t\u011bnce do p\u00e9\u010de informace pot\u0159ebn\u00e9 k zaji\u0161t\u011bn\u00ed n\u00e1vaznosti zdravotn\u00ed p\u00e9\u010de (tzv. v\u00fdpis se\u00a0zdravotn\u00ed dokumentace pacienta v\u010detn\u011b informace o p\u0159edchoz\u00ed \u00fahrad\u011b zubn\u00edch n\u00e1hrad ze\u00a0zdravotn\u00edho poji\u0161t\u011bn\u00ed) a p\u0159edchoz\u00ed registruj\u00edc\u00ed l\u00e9ka\u0159 je povinen mu tyto informace p\u00edsemn\u011b p\u0159edat.<\/p>\n

\u00daprava sn\u00edmateln\u00fdch n\u00e1hrad<\/b><\/h6>\n

Zubn\u00ed l\u00e9ka\u0159 by m\u011bl pravideln\u011b (nejl\u00e9pe jednou ro\u010dn\u011b b\u011bhem preventivn\u00ed prohl\u00eddky) kontrolovat stabilitu a p\u0159ilnavost zubn\u00ed n\u00e1hrady, stav sliznice a m\u011bkk\u00fdch tk\u00e1n\u00ed \u00fastn\u00ed dutiny. Pokud poji\u0161t\u011bnci sn\u00edmateln\u00e1 n\u00e1hrada nesed\u00ed \u010di\u00a0mu\u00a0zp\u016fsobuje bolest, je pot\u0159eba o tom sv\u00e9ho zubn\u00edho l\u00e9ka\u0159e informovat.<\/p>\n

Pokud zubn\u00ed n\u00e1hrada v \u00fastech p\u0159esn\u011b nesed\u00ed, m\u016f\u017ee v \u00fastn\u00ed dutin\u011b vytv\u00e1\u0159et otlaky zp\u016fsobuj\u00edc\u00ed bolest. Z\u00a0tohoto d\u016fvodu je pot\u0159eba zubn\u00ed n\u00e1hradu \u010das od \u010dasu upravovat a p\u0159izp\u016fsobit \u00fastn\u00ed dutin\u011b. Jednoduchou \u00fapravu sn\u00edmateln\u00e9 n\u00e1hrady hrazenou ze zdravotn\u00edho poji\u0161t\u011bn\u00ed m\u016f\u017ee zubn\u00ed l\u00e9ka\u0159 ve sv\u00e9 ordinaci prov\u00e9st a\u017e 5x za kalend\u00e1\u0159n\u00ed rok (nejd\u0159\u00edve dva m\u011bs\u00edce po odevzd\u00e1n\u00ed nov\u00e9 sn\u00edmateln\u00e9 n\u00e1hrady).<\/p>\n

M\u016f\u017ee ode m\u011b zuba\u0159 vy\u017eadovat \u00fahradu?<\/b><\/h6>\n

Sou\u010d\u00e1st\u00ed \u00fahrady za sn\u00edmatelnou n\u00e1hradu jsou ve\u0161ker\u00e9 proveden\u00e9 \u00fakony, v\u0161echny v\u00fdrobn\u00ed f\u00e1ze\u00a0<\/b>(nap\u0159. otisk \u010delisti v\u00a0individu\u00e1ln\u00ed l\u017e\u00edci, zhotoven\u00ed v\u00fdztu\u017ee), kter\u00e9 se prov\u00e1d\u011bj\u00ed b\u011bhem\u00a0n\u00e1v\u0161t\u011bv poji\u0161t\u011bnce p\u0159i zhotovov\u00e1n\u00ed n\u00e1hrady.<\/b><\/p>\n

Zubn\u00ed l\u00e9ka\u0159 nem\u016f\u017ee od poji\u0161t\u011bnce za zubn\u00ed n\u00e1hradu\u00a0<\/b>(celkovou nebo \u010d\u00e1ste\u010dnou) v\u00a0z\u00e1kladn\u00edm<\/b>\u00a0proveden\u00ed<\/b>\u00a0po\u017eadovat p\u0159\u00edmou platbu. V\u00a0p\u0159\u00edpad\u011b zubn\u00ed n\u00e1hrady<\/b>\u00a0(celkov\u00e9 nebo \u010d\u00e1ste\u010dn\u00e9)\u00a0ostatn\u00ed<\/b>\u00a0dopl\u00e1c\u00ed\u00a0poji\u0161t\u011bnec\u00a0<\/b>rozd\u00edl mezi \u00fahradou zdravotn\u00ed poji\u0161\u0165ovny a celkovou cenou za zubn\u00ed n\u00e1hradu.<\/a><\/p>\n

Povinnost informovat poji\u0161t\u011bnce o cen\u00e1ch<\/b><\/h6>\n

Poji\u0161t\u011bnec m\u00e1 p\u0159i poskytov\u00e1n\u00ed zdravotn\u00edch slu\u017eeb pr\u00e1vo b\u00fdt p\u0159edem informov\u00e1n o cen\u011b poskytovan\u00fdch zdravotn\u00edch slu\u017eeb nehrazen\u00fdch nebo \u010d\u00e1ste\u010dn\u011b hrazen\u00fdch z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed<\/b>\u00a0a\u00a0o\u00a0zp\u016fsobu jejich \u00fahrady.<\/b>\u00a0Poskytovatel m\u00e1 tak\u00e9 povinnost zpracovat seznam cen t\u011bchto slu\u017eeb a um\u00edstit ho tak, aby byl p\u0159\u00edstupn\u00fd pacient\u016fm.<\/b>\u00a0Povinnost\u00ed poskytovatele je tak\u00e9 poji\u0161t\u011bnci vystavit \u00fa\u010det za uhrazen\u00e9 zdravotn\u00ed slu\u017eby.<\/p>\n

(vzp)<\/strong><\/p>\n

\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

OT\u00c1ZKA: Jak <\/p>\n","protected":false},"author":2,"featured_media":304922,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"gallery","meta":{"footnotes":""},"categories":[88],"tags":[],"jetpack_featured_media_url":"https:\/\/zakrasnejsivimperk.cz\/wp-content\/uploads\/2024\/04\/22\/ram-vzp.jpg","_links":{"self":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/304920"}],"collection":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=304920"}],"version-history":[{"count":2,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/304920\/revisions"}],"predecessor-version":[{"id":304923,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/304920\/revisions\/304923"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/media\/304922"}],"wp:attachment":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=304920"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=304920"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=304920"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}