In 2026, a package of changes will come into effect which will have significant impact on the area of public health insurance in the Czech Republic. The changes will affect employers, employees, self-employed persons, and persons for whom the state pays the insurance contributions.

The minimum wage is increasing, and with it the amounts for contributions; the limits for insurance contributions for agreements on work performed outside of employment are changing; the definition of self-employed persons is being clarified; and new rules are being set for persons caring for children. Along with this, reporting obligations are also changing, processes involving health insurance companies are being digitized, and deadlines for prescribing and enforcing insurance debts are being unified.

In practice, 2026 will bring not only new amounts and definitions, but also new administrative “barriers” that will need to be prepared for in advance, especially in the areas of HR and payroll. In this article, we summarize the key changes to health insurance in the Czech Republic and highlight points that should not be overlooked.

1. The Essential Numbers

In 2026, the minimum wage will increase to CZK 22,400 per month, while the minimum hourly wage will increase to CZK 134.40. The increase in the minimum wage will also cause an increase in the average wage, which will reach CZK 48,967 in 2026. The decisive income for employee participation in health insurance will remain unchanged in 2026, continuing to be CZK 4,500 per month.

For agreements to complete a job (DPP), the threshold for the obligation to pay social security and health insurance contributions has been raised to CZK 12,000 per month (in 2025, it was CZK 11,500). In the case of agreements to perform work (DPČ), the decisive income for insurance contributions will remain the same in 2026, i.e., CZK 4,500 per month.

For self-employed persons, participation in sickness insurance will continue to be voluntary. In the case of health insurance, self-employed persons will be required to pay a minimum advance payment of CZK 3,024 in 2026. Self-employed persons falling into zone I (of the flax-rate tax) should also take note, as the monthly advance payment in this zone will increase to CZK 9,984. On the other hand, nothing will change for self-employed persons in zones II and III of the flat-rate tax, where monthly advance payments will remain the same as in 2025, i.e., CZK 16,745 for zone II and CZK 27,139 for zone III.

2. Changes to the Public Health Insurance Act

From January 2026, amendments to Act No. 48/1997 Coll. on public health insurance (the “APHI”), which regulates the conditions and rules for the provision of healthcare and the financing of health insurance in the Czech Republic, will come into effect.

Cooperatives and Communities of Unit Owners

From 2026, members of a cooperative (in Czech: členové družstva) in an employment relationship with the cooperative will be obliged to pay health insurance contributions only if their remuneration exceeds the decisive income, i.e. CZK 4,500 per month. Similarly, members of a community of unit owners (in Czech: Sdružení vlastníků jednotek – SVJ) will be required to pay health insurance contributions only if their remuneration exceeds the decisive income, i.e., CZK 4,500.

Witnesses

The law now explicitly stipulates that witness remuneration or compensation for lost earnings for giving testimony in court, administrative, or other proceedings is not considered employee income for health insurance purposes, and therefore no insurance contributions are deducted from this amount.

Self-employed Persons

The amendment to the APHI also brings changes for self-employed persons. From January 2026, the definition of the term “self-employed person” for health insurance purposes will be clarified, whereby a person will now be considered self-employed if he/she:

• generates income from independent activities under the Income Tax Act,
• carries out activities that generate income from independent activities in accordance with the Income Tax Act.

Therefore, from 2026 onwards, not only those who actually run a business will be considered self-employed, but also those who have income from some independent activity, even if they do not actually perform it.

Caregivers

Another change concerns the payment of health insurance for persons caring for children. From January 2026, the state will only pay insurance for persons caring for children under the age of 7. Those affected by the amendment will be informed by the relevant authorities of the change. The caregivers concerned will then have to confirm that they wish to continue to fall into the category of caregivers for whom the state pays health insurance.

Reporting Obligations and Provision of Information

There are also changes in the area of employers’ reporting obligations. Until 31 December 2025, employers are required to notify the relevant health insurance company within eight days of any circumstances that constitute the commencement or termination of the state’s obligation to pay insurance premiums for a given person, regardless of the reason for this circumstance (old-age pension, person caring for a helpless person, etc.).

From 1 January 2026, employers will only be required to report information relevant to the state’s obligation to pay insurance contributions for women on maternity leave or persons on parental leave. Employers will report this information electronically to the relevant health insurance company only once a month, by the 20th day of the following calendar month.

The amendment also brings administrative relief to the insured persons themselves. Given the interconnection with various institutions, health insurance companies have access to a considerable amount of information that is decisive for classifying the insured into the relevant state category within the meaning of Sec. 7 of the APHI. From January 2026, insured persons will therefore not be required to report all facts to their health insurance company, but only those that the health insurance company will not be able to obtain from another institution.

From 1 January 2026, the process of changing health insurance companies will also be simplified. The original health insurance company will have to provide the new health insurance company with information on the facts relevant to the state’s obligation to pay insurance contributions for the insured person and, in the case of self-employed persons, also information on the amount of advance payments within one month from the date of the change.

3. Changes to the Act on Public Health Insurance Contribution

In addition to the above-mentioned changes in the Act on Public Health Insurance, next year will also bring changes to Act No. 592/1992 Coll., on Public Health Insurance Contributions (the “PHICA”).

Self-employed Persons

From 1 January 2026, the minimum assessment base will not apply to persons who perform only secondary activities as self-employed persons (e.g., students, pensioners, parents on parental leave, etc.). The annual health insurance contribution will now be calculated from the actual assessment base, which is half of the tax base, and the minimum assessment base does not have to be observed, as is the case when performing main self-employment activities.

From next year, the conditions under which the minimum assessment base for calculating health insurance contribution is reduced for self-employed persons will be further extended. Specifically, this applies to the following situations where self-employed person:

• was not self-employed throughout the entire relevant period (e.g., started or terminated business during the year),
• received sickness benefits or maternity benefits (from sickness insurance as a self-employed person),
• and, newly, received long-term care sickness benefits (from self-employed persons’ sickness insurance).

Another change that 2026 brings for self-employed persons is in the area of advance payments. Under the new rules, no self-employed person who is not subject to the minimum assessment base will have to pay advance payments in the first year of self-employment, meaning that the exemption no longer depends on whether the state is the payer of insurance contributions.

It remains effective that self-employed persons who are also employees are not required to pay advance payments and will pay the insurance contributions after submitting their report for the previous calendar year.

Most self-employed persons already submitted their reports electronically. From 2026, all self-employed persons will have to do so in a manner specified by their health insurance company.

Employers

From 2026, employers will be required to submit a corrective report within eight days if they subsequently discover an error or change in a previously submitted insurance contribution payment report (e.g., incorrectly calculated insurance contributions, addition of an employee, identification error). Reports (regular or corrective) can again only be submitted electronically.

Insurance Debts and Instalments

The year 2026 also brings changes in the approval of insurance contributions instalments for the purpose of debt repayment. Health insurance companies may conclude agreements with debtors on the repayment of outstanding insurance contributions (given the status of health insurance companies, these will be public law contracts). If no agreement is reached, the insurance company may issue a decision unilaterally approving the installments. In both cases, it is always up to the insurance company to decide whether or not to approve the installments. It is also the insurance company that determines the terms of repayment.

The health insurance company will not approve the instalment schedule if the payer is in liquidation or insolvency, i.e. if a decision has been made on their bankruptcy.

In the same way that an insurance company is entitled to unilaterally decide on payments and determine the conditions, it is the insurance company that can also:

• cancel the installment plan if the payer fails to make a payment on time or in full,
• change the decision if the amount of debt changes,
• revoke the approval if the debtor enters into liquidation or insolvency.

Deadlines for the Collection of Insurance Contributions and Penalties

The amendment to the PHICA unifies and clarifies the deadlines during which a health insurance company can prescribe the due insurance contribution and subsequently collect it.

The health insurance company has six years from the due date of the insurance contribution to prescribe the debt, provided that if the insurance company takes active steps during this period (e.g., conducts an inspection or issues a decision), a new six-year period always begins on the date when the payer becomes verifiably aware of these steps.

The debt can be recovered for 6 years from the moment it was “formally confirmed” (by a decision or statement of arrears). However, the insurance company will not lose the claim if it actively recovers the debt during this period (e.g., through court or execution proceedings). If the debtor raises an objection that the limitation period has expired, the insurance company must take this into account and refrain from enforcing the debt.

Despite possible interruptions or suspensions of the limitation period as regulated by the PHICA, the insurance company’s right to collect the debt expires definitively 20 years after the final decision or prescription of the debt.

When discussing due insurance contributions, it is necessary to at least briefly mention that the PHICA allows for the institution of liability for due insurance contributions. This applies, for example, to legal representatives (e.g., parents) and their liability for insurance contributions owed by a minor insured person.

Although non-payment of insurance contributions is usually associated with a penalty, there are situations in which the health insurance company will not impose the penalty:

• if the penalty for the entire calendar year does not exceed CZK 100 (previously CZK 200),
• if the payer proves that he/she paid the insurance contribution to the correct insurance company’s account but entered the wrong variable symbol.

Refunds of Overpayments

From 2026, the limitation period for claims for refunds of overpayments will be unified. It will now be six years from the calendar year in which the claim arose (note: until 2025, the claim expired after 10 years).

The health insurance company is obliged to refund the overpayment of insurance contributions within one month from the date on which it became aware of this fact.

Other Changes

As part of the overall digitization process from 2026, it will be possible to pay insurance contributions exclusively electronically. Cash payments at health insurance company branches will no longer be accepted.

Last but not least, the amendment to the PHICA specifies who shall acquire the obligation to pay the due insurance contributions if the original payer is not available, namely:

• If a legal entity (e.g., a company, association, cooperative) ceases to exist and has a legal successor, the obligation to pay insurance contributions passes to that successor.
• If a natural person who was obliged to pay insurance contributions dies, his/her obligation passes to his/her heirs.

4. Recommendations and What You Not to Forget

From January 2026, employers will no longer report all facts that affect whether the state pays insurance contributions for employees (e.g., studies, caregiving, disability, etc.). We therefore recommend that employers inform their employees that they must now report these changes (which are decisive for classification into the so-called state categories) to their health insurance company themselves.

We also recommend informing employees that they have additional obligations related to their participation in health insurance. When starting employment, they must inform their employer which health insurance company they are insured with. However, their obligations do not end there; employees must also notify their employer:

• if they switch to another health insurance company,
• if they become (or cease to be) an insured person for whom the state pays insurance contributions (student, pensioner, etc.).

If employees fail to comply with their reporting obligations, the employer may incur penalties for incorrectly paid insurance premiums, which it has the right to recover from the employee.

In connection with the above-mentioned obligations of employees, employers must now confirm in writing to employees that they have received their notification of health insurance or of a change. The confirmation may be issued in paper or electronic form and serves as proof that the employee has fulfilled the obligation. It thus protects both parties in the event of a dispute over incorrectly paid insurance contributions.

Conclusion

In conclusion, it should be emphasized that 2026 will bring a relatively large number of changes to Czech public health insurance that will affect not only employers, but also self-employed persons and employees. New administrative obligations and more precise rules for contributions and reporting require a review of the current settings and the possible introduction of necessary changes. We are happy to help you with all the necessary formalities, so please do not hesitate to contact our team of Czech experts.

Aneta Zichová

Associate | Accace Czech Republic

Get in touch with us