The National Assembly has passed a bill that transforms supplementary health insurance, a flat-rate monthly payment that is voluntary but needed for most health services, into a mandatory contribution attached to regular health insurance premiums. From next year, the payments will no longer be collected by private insurers.

The reformed system is scheduled to take effect on 1 January 2024. In the meantime, the supplementary health insurance premium, now collected by three private insurance companies, has been frozen at just over €35 per month.

The mandatory contribution will be at a fixed amount of €35 a month, with the possibility of adjustment once a year. It will be collected mostly by the Financial Administration, but in some cases it will be collected by the public health insurance fund manager ZZZS, which already manages the mandatory health insurance contributions where those with higher earnings pay more.

Law prompted by premium hikes

The government decided to scrap supplementary insurance after private insurers announced considerable price hikes earlier this year with the argument that they are losing money since the cost of services has skyrocketed.

The insurers were initially accused of taking advantage of inflation to fill their pockets, but calculations by the ZZZS and insurers' own balance sheets show they are indeed losing money on health insurance.

Shortfall to be covered by budget

The law determines that shortfalls will be covered by the budget, which is seen as the biggest risk of the new system and which posed an obstacle to attempts to scrap top-up health insurance in the past.

To alleviate the concerns, a budget safeguard was introduced during the legislative process to limit budget liability to €240 million in 2024. Finance Minister Klemen Boštjančič has said that a more comprehensive solution should be found going forward.

Coalition: Historic moment

In passing the bill reforming the Health Care and Health Insurance Act on 6 July, the ruling coalition hailed the abolishing of the top-up health insurance as an "historic moment" after several governments attempted to do so but failed.

The junior coalition partners, the Left and Social Democrats (SD), expect that the fixed contribution is an interim solution and will soon be replaced by a fairer system where those who earn less will pay less.

Trade unions have also been calling for a contribution proportionate to the person's income.

Opposition raises concerns

The opposition raised potential negative consequences bearing on the budget and people. The Democrats (SDS) argued the bill did not in fact abolish supplementary health insurance but merely made it mandatory, which changed nothing.

"It does not bring better solutions, it does not tackle wait times or any other key problem in the health system," SDS MP Zvone Černač said.

Both the SDS and fellow opposition New Slovenia (NSi) said that even if people pay less in supplementary health insurance they would pay more in taxes and contributions.

NSi MP Iva Dimic said the government failed to provide calculations as to how much the transformation of top-up health insurance would cost.

"We can say they have been blinded by greed and desire to control the money paid into voluntary insurance, as the bill says nothing about how much the ZZZS's reorganisation will cost and how many people will have to be employed, how much money will be spent on software, equipment and premises," she said.

Change to affect private insurers

Once the change is implemented, the ZZZS will remain as the single payer in the health insurance system. Meanwhile, private insurers will continue to offer premium services such as second opinions and fast checkups that bypass the public system.

The government plans to transform the biggest among them, Vzajemna, from a mutual health insurer into a regular joint stock company.

Top-up health insurance was introduced in 1993 to meet the need for more money in healthcare. Initially the Health Insurance Institute (ZZZS) collected both basic mandatory insurance and top-up insurance. When Vzajemna was founded in 1999 as a mutual health insurer it took over top-up insurance.

Later on, two more insurers started providing this type of insurance, Triglav, and Adriatic Slovenica. The latter has since been acquired by Generali.

Ideas that top-up health insurance should be abolished or folded into mandatory insurance have been discussed for more than two decades and all centre-left governments to date have promised to tackle the matter, but failed. Several health ministers quit over the issue in the past.