Kód pojišťovny

Application for registration of an insured person with the ČPZP – foreigner under 18 years of age with long-term residence in the Czech Republic

Personal data

Fill in your social security number if you have already been assigned to another health insurance company in the Czech Republic (you can find your social security number on your health insurance card)

Address of residence in the Czech Republic

General information

Insert a photo of the Residence Permit document (1 photo = 1 document), or PDF document.
Only fill in if you have already arranged comprehensive health insurance for foreigners.
Fill in only if you have already been insured with a health insurance company in the Czech Republic.
Insert a photo of your travel document

Legal ambassador

Insert a photo of the document officially proving the bond with the child, i.e. birth certificate or court decision on guardianship or custody (1 photo = 1 document)
Insert a photo of your travel document

I request the delivery of the Insured Person's Record for a physical signature through the ČPZP courier service. In the coming days, you will be contacted for the signing of the Insured Person's Record by the ČPZP courier service. They will coordinate its delivery with you via the phone number provided in the online form.

Fields marked with * are mandatory
Notice

1. Complete a simple form containing necessary basic information. The online form completion applies only to the registration of foreigners under 18 with long-term residence in the Czech Republic.

 

2. After electronically submitting the form, a courier from the Czech Industrial Health Insurance Company will contact you to confirm registration with ČPZP by obtaining your handwritten signature on the Insured Person's Record. We will print this record based on the information you provided. Registration is not valid without a signature. To achieve this, it is necessary to consent to the processing of personal data for courier delivery.

 

3. After signing the Insured Person's Record, the registered minor policyholder will be assigned a birth number for the Czech Republic and will become a policyholder of ČPZP from the date of the long-term residence permit or from the following day after ending private comprehensive health insurance for foreigners.

 

4. You will receive the health insurance card by mail after returning the signed Insured Person's Record.

 

From January 1, 2024, all foreigners under 18 with valid long-term residence permits are newly participants in public health insurance. Registration for public health insurance is mandatory within 8 calendar days. Failure to register will result in a debt to the legal representative of the minor child.

If a person under 18 has valid private health insurance after January 1, 2024, they become a participant in public health insurance the day after ending private comprehensive health insurance for foreigners.

Participation in public health insurance is mandatory by law. It is not possible to choose whether to be insured under public or private health insurance.

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