*Complementary Health Insurance in Slovenia DOI: http://dx.doi.org/10.5772/intechopen.105150*


*insurance; HCHI—The Health Care and Health Insurance Amendment Act; MoH—Ministry of Health; VHI voluntary health insurance. Source: European Commission, 2012 [10]; Sagan A, Thomson S, 2016 [11].*

#### **Table 1.**

*Development and regulation of CHI in Slovenia, 1992–2012.*

raise additional funds for health care in addition to the funds from the compulsory health insurance and served to diversify the sources of funding. Originally, there were two providers of CHI: HIIS, and Adriatic, a for-profit commercial provider [11, 12].

In 1993−1994, mainly large companies concluded collective agreements with CHI for their employees. After initial fears that a two-class medical system would emerge, this later became a matter of individual choice. However, it was argued that the introduction of the CHI system would put an end to unlimited entitlements and the use of the compulsory health insurance system, as consumers would have to raise additional funds [11, 12].

In 1998, the Health Care and Health Insurance Act [7] was amended in such a way that the HIIS had to separate its compulsory insurance and CHI. As a result, a new non-profit mutual insurance company, Vzajemna, was established, independent of the HIIS, which subsequently became the largest provider of CHI. Ever since CHI has been on the market, there have been clear signs of imbalances between the various CHI companies. The equity problems became apparent when CHI introduced a regressive element into the system due to its flat-rate premiums (i.e., not risk-based). At that time, premiums for CHI were not risk-based and two companies (Adriatic and Vzajemna) charged identical premiums [11, 12].

When the two commercial companies offering CHI entered the Slovenian market in 2004–2005, they launched an obvious advertising campaign for younger and healthier policyholders with risk-based premiums. CHI is regulated by the Insurance Supervisory Authority (premiums level) and the MoH (market entry, approval of initial premiums, risk equalisation procedure). It does not receive tax subsidies. The CHI market is subject to relatively strict regulation, and some argue that these rules violate EU regulations [11, 12].

In 2006, the amendment to the Health Care and Health Insurance Act 2005 [7] came into force. In response to the introduction of the Community Rating, premiums increased by 18% and by a further 5% due to rising health costs. In June 2006, Vzajemna complains to the European Commission (EC) about the shortcomings of CHI (**Table 1**). In 2007, the EC issued an official warning regarding Slovenia's health insurance legislation. The government had argued that CHI, which covers the copayments for most of the services in the basic benefit package, despite its voluntary nature, is an integral part of compulsory health insurance and a matter of public interest for the protection of the common good.

In 2011, EC took Slovenia to the European Court of Justice (ECJ) for failing to amend the CHI legislation. As a result, the MoH proposed to reform the health system by 2020 and abolish CHI with a redefined publicly funded benefits package. In 2012, the Public Finance Balancing Act was passed, resulting in a shift of costs from the public to the private sector and a 13% increase in CHI premiums to cover user fees [11]. The European Court of Justice confirms that Slovenian legislation on the CHI does not fully comply with the non-life insurance directives. The ruling concerns, among other things, the use of profits, systematic reporting, and prior authorisation; it does not concern risk equalisation [11]. After several reminders, EC decided to refer the issue of this non-life insurance (health insurance) to the ECJ, which resulted in a ruling by the ECJ declaring that the provision of CHI in Slovenia is in breach of the Non-Life Insurance Directive. No direct penalty was imposed, but the Slovenian government was ordered to put an end to the infringement and to inform EC of the decision [10].
