Revolution in health insurance: what will digitalisation bring from 2025?

Changes to the sickness insurance agenda from 1 January 2025: what should employers know?

With the digitalization of the state administration, the Czech Social Security Administration (CSSA) is coming up with another significant change in the area of sickness insurance. From 1 January 2025, the electronic form of other sickness insurance benefits will be introduced. This change follows the successful introduction of eSick leave in 2020, which simplified administrative processes related to sick leave

Which benefits will be digitised?

From the new year, the following benefits will be electronically administered

• Sick pay
• Long-term care benefits
• Maternity allowance
• Paternity
• Pregnancy and maternity compensatory allowance

The process for administering these benefits will be similar to that for eSick Pay. This move is expected to speed up communication between the doctor, the employer, the CSSA and the client

How will this work?

1. Electronic issuance of the decisionThe attending physician or other authorised body will electronically create a new case and the system will generate a unique identifier (decision or certificate number). The patient reports this identifier to his/her employer.
2. Informing the clientThe patient provides the doctor with contact details (telephone or e-mail), where he/she receives a message from the CHSS with the following information
   • Case identifier
   • Type of benefit and date of occurrence
   • Link to the ČSSZ ePortal for details
   • Instructions for forwarding information to the employer
3. Application for benefitThe employee informs the employer of the occurrence of the social event and applies for the relevant benefit. At the same time, he/she submits documents certifying that the conditions of entitlement have been met, if necessary (e.g. a decision on the adoption of a child).
4. Employer’s communication with the CSSAThe employer submits to the CSSA the form ‘Employer’s notification of the employee’s claim for benefit’ (NEMPRI_2025). This form contains the employee’s data needed to calculate the benefit. The paper documents will be converted into electronic form and sent by data message.
5. Payment of the benefitThe CSSA will pay the benefit in the same way as the employer pays wages, unless the employee requests a different method of payment.

What to do when switching to the new system?

For cases arising before 1 January 2025, the existing rules apply. However, if a doctor makes a benefit decision after this date, the new legislation will need to be followed, including the use of new forms and digital processes

Advice for employers

• Set up clear procedures for communicating benefit information from employees (e.g. email, SMS, HR system).
• Familiarise yourself with the recommended notification templates available on the CSSA website.
• Inform employees of the changes and requirements that will be in place from 1 January 2025.

Support for employers and software developers

Detailed information on the new procedures, forms and integration into payroll and HR systems can be found on the CSSA website

Conclusion

The digitisation of sickness insurance represents another step towards simplifying administration and increasing efficiency. We believe that these changes will make work easier not only for employers but also for employees and will contribute to the smooth functioning of the entire system. 💡How to do it simply and efficiently with JOBka? With JOBka we have prepared a solution that will make it much easier for you to meet these legislative requirements. Take inspiration from the successful implementation at our customer Sconto CZ and choose from the following options

1. Standard Forms

Four pre-prepared forms that we will set up directly in your JOBka application

2. Forms with automatic responses

In addition to the standard forms, you will also get the ability to automatically reply to employees on status changes or provide comments from the payroll accountant – My Replies module + 4 Overviews (of the employee’s submissions).

Both options allow you to attach a photo with an identifier, or any other necessary document. Watch a demonstration of how easily it can work. We have prepared a short video (implementation in Skont) where you can get acquainted with our solution in more detail.