LAW NO. 212 of 27th May 2004
Law of the private health insurances

ISSUER: THE PARLIAMENT
PUBLISHED IN: THE OFFICIAL GAZETTE No. 505 of 4th June 2004

The Parliament of Romania adopts the present Law.

Chapter 1
General provisions

ARTICLE. 1
The private health insurances for the payment of the medical services is a facultative system, supplementary to the compulsory health insurances, which covers the medical service s within the conditions of the legislation related to the organization and the functioning of the health social security insurance.
ARTICLE 2
Within the sense of the present law, the herein below expressions are defined as follows:
a) the basic services package consists of the services covered by the health social security insurance, according to the legal provisions in force;
b) the supplementary services package means the services covered by a private health insurance, agreed by a contract of private health insurance.
ARTICLE 3
(1) within the meaning of the present law the private health insurances may be insurances of complementary, supplementary and substituting types.
(2) the private health insurances cover totally or partially the payment of services that are partially excluded by the health social security from the basic package including the co-payments as appropriate.
(3) the private health insurances of supplementary type cover totally or partially the payment of services exceeding the basic package of the health social security related to supplying the high degree of comfort, the rapid access to the medical services within the waiting lists , special medical services abroad and other services.
(4) the private health insurances of substitution type cover totally or partially the payment of any services including those provided for in the article 29 (a )
ARTICLE 4
(1) Any persons, Romanian citizen, foreign citizen or stateless person having the domicile or, as appropriate, the residence in Romania, who meets the compulsory conditions of the health social security concludes contracts with private health insurance undertakings, hereinafter called insurers and pays the insurance premium is eligible for the services offered by the private health insurance system.
(2) The European Union citizens as well as the citizens of the state with which Romania concluded agreements, conventions or international protocols of cooperation in the heath and medical scientism fields are eligible to the services offered by the private health system without the need of complying with the requirements of the health social security if the agreements, conventions and the international protocols concluded by Romania with the respective states do not provide otherwise.
ARTICLE 5
(1)The assureds are individuals that have a private health insurance concluded with an insurer directly or through the medium of a third party.
(2) The employers, individuals or moral persons, can conclude contracts of private health insurance for their employees, individually or for the group, allowed as additional employment benefits with the view of attracting, selecting or stabilizing the employed personnel.
(3) Any private or public unit providing medical services can concluded contracts with the authorized private health insurance undertakings.
(4) The authorized private health insurance undertakings may set up consulting rooms, hospitals and other medical services units according to the law.
ARTICLE 6
The private health insurances offered by the private health insurance undertakings are medical and pharmaceutical services that are established by the private health insurance undertakings as service packages depending on the individual risk.
ARTICLE 7
In the private health insurance system the selection of medical services suppliers by the assured and the insurer is free.

CHAPTER 2
The set up, the authorization and the functioning of the private health insurance undertakings

ARTICLE 8
The set up, the authorization and the functioning of the private health insurance undertakings will be done in conformity with the legal provisions regulating the insurance activity.
ARTICLE 9
The insurance undertakings may function only if they have as well the private health insurances in their object of activity.
ARTICLE 10
The insurance undertakings authorization will be made by the Insurance Supervisory Commission within the conditions of the law.
ARTICLE 11
(1) The insurers are obliged to reinsure in accordance with the law.
(2) The reinsurance operations supplements the insurance activity.
ARTICLE 12
The management of the private health insurance undertaking will be performed in accordance with the law provisions regulating the insurance activity supplemented by the commercial law provisions.

CHAPTER. 3
The private health insurance undertakings activity.
ARTICLE 13
(1)The private health insurance activity is based upon contract between the parties and upon the insurance document called insurance policy.
(2) The private health insurance activity is carried out by contract concluded with the medical and pharmaceutical services suppliers and the individual and the moral persons in their capacity as assureds and or the insurers.
(3) The private health insurance means the operation by which an insurer sets up, upon the mutuality principle an insurance fund by the contribution of a number of assureds that are exposed to certain risks occurrence and indemnify those using the supplementary package of medical services on account of the fund consisting of collected premiums as well as other incomings arising out from the carried activities.
ARTICLE 14
The insurers will individualize the supplementary package in the contract of insurance in accordance with the article 2 ( b) as well as the medical services that are excluded or those applying with restrictions.
ARTICLE 15
(1) The assureds have the right to be informed by the private health insurance undertaking of the medical services allowed, the insurance premiums the contractual rights and obligations, in details.
(2) The private health insurance undertakings have the obligation to present the necessary data in respect of the rights and the obligations of the assured person at the conclusion of the contract of insurance with him. The information contained by the contract are confidential and cannot be disclosed by the private health insurance undertaking to the third persons, with the exception of the cases provided for in the law.
ARTICLE 16
The payment of the expenses to the suppliers of medical services allowed to the assureds is effected on the basis of justifying documents of the respective payments.
ARTICLE 17
The liquidation, dissolution, reorganization and the winding up of the private health insurance undertakings will be done according to the legal provisions in force.

CHAPTER 4
The contract of private health insurance.

ARTICLE 18
(1) The relationships between the assured and the insurer, the rights and the obligations of each of the parties are established by the contract of private health insurance.
(2) The contract of private health insurance must contain:
a) the names and the registered addresses of the contracting parties, the series and the registration number of the contract , the single code of registration and the insurer registration number from the Register of Commerce;
b) the type and the volume of medical services and other services ;
c) the insurance conditions for the medical services that are warranted by the insurers to the assureds;
d) the date of the beginning and the cease of insurance;
e) the insurance premiums , the due date and the way of payment ;
f) the insured sums;
g) other elements that mentions the rights and the obligations of the parties.
ARTICLE 19
By the contract of private health insurance the assured undertakes to pay the private health insurance premium to the insurer and this undertakes that, upon the occurrence of one of the risks assumed by contract, to pay on behalf of the assureds the type of medical services conditional upon the quantity and the quality of the medical act and the individual risk and other services supplied by the suppliers, within the limits and the terms agreed as well as the relevant expenses related to the service sin discussion.
ARTICLE 20
The private health insurance premium is paid by an individual or the employer that concludes a private health insurance contract.
ARTICLE 21
The insurer may require information related to the assureds status of health as well as a medical check for the evaluation of the solicitant health by an medical services supplier that was designated by him.
ARTICLE 22
The private health insurance undertaking pays the counter value of medical services that were proved according to the contract and the insurance policy.
ARTICLE 23
The private health insurance expenses born by the individual or the employer are tax deductible.
ARTICLE 24
The disputes intervened between the insurer and the medical service suppliers are amicably mediated. In the case of non-settlement by amicable way, the legal disputes will be submitted to the Court in jurisdiction.
ARTICLE 25
The disputes intervened between the assured and the insurer will be settled according to the legislation in force and those provided for in the contract concluded by the parties.

CHAPTER 5
The specialized supervision of the private health insurances.

ARTICLE 26
The insurers have the obligation to organize internal control proceedings to ensure the activity being carried out in accordance with the legal and prudential requirements.
ARTICLE 27
The insurers appoint an independent financial auditor, authorized to carry out such activity in Romania.
ARTICLE 28
The Ministry of Health has the obligation to supervise the complying with the legislation in force in the medical and pharmaceutical filed through authorized persons in this respect by the Minister of Health.
ARTICLE 29
The Insurance Supervisory Commission personnel is bound by professional confidentiality as far as the information received is concerned. Supplying of any information is possible only upon the individuals concerned or the employees in question or, in the cases provided for by the law, by written request of the public prosecutor or the Court of justice.
ARTICLE 30
The insurance undertakings will at the request of the Insurance Supervisory Commission disclose the information and the documentation related to the private health insurances for which they are authorized to act.
CHAPTER 6
Penalties

ARTICLE 31
Bad faith presentation by the solicitant of the contract of insurance of unreal information related to his health statements, may lead to the contract rescinding.
ARTICLE 32
The non-payment by the insurance undertaking of the expenses covering the medical services supplied by the suppliers of medical services or the delayed payment beyond 30 days from the due date will result in calculation of penalties according to the contract provisions.
ARTICLE 33
The breach of the present law dispositions and the regulations to apply the law, is found by the personnel authorized by joint order of the Ministry of Health and the Insurance Supervisory Commission.

CHAPTER 7
Transitory and final dispositions.

ARTICLE 34
The present law dispositions are supplemented, as appropriate, with the legislation related to the insurance undertakings and the supervision of insurance.

ARTICLE 35
The Ministry of Health together with Insurance Supervisory Commission will elaborate the methodological regulations and instructions related to application of this law within 90 days as of the date of its publication in the Official Gazette of Romania, Part I.
ARTICLE 36
The present law enters into force at 90 days as of its publication in the Official Gazette of Romania, Part I.

This law has been adopted by the Senate in its meeting of 3rd May 2004, observing the provisions of the article 76 (1) of the Constitution of Romania republished.

p. PRESIDENT OF THE SENATE,
DAN MIRCEA POPESCU

This law has been adopted by the Chamber of deputies in its meeting of 4th May 2004, observing the provisions of the article 76 (1) of the Constitution of Romania, republished.

PRESIDENT OF THE CHAMBER OF DEPUTIES
VALER DORNEANU