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International students who come from non-European countries have, in most cases, a private insurance which was required for the visa application. But this insurance covers mostly only accidents and do not cover general practitioner’s consultation. For a general medical care insurance (Voluntary Health Insurance for Students from Foreign Counties) you have to apply in the NFZ department. Below you can find instruction how to do it.
Block I:
Item 01 –„4” means the deadline for submission of declarations
Item 02 – the number of declaration, month, year for which a declaration is made up
Block II:
It should be completed in accordance with the declaration on the document ZUS ZZA
Block III:
Item 01 –„1” – one person insured
Block VII:
Item 01 and 04 – the amount of premium
Block IX:
Item 01 – the amount of premium
Block XI:
Item 01 – code for the title insurance„24 10 00”
Item 04 – the basis on which a premium is charged
Block XII:
Item 08 – the date of completion of the document
Item 09 – signature
Block I:
Item 01 – mark the declaration „X” (means registration)
Block II:
Item 01 – (NIP) Tax Identification Number
Item 03 – (PESEL) Personal Identification Number
Item 04 – number 2
Item 05 – the number of passport
Item 07 – surname
Item 08 – first name
Block III:
Repeat the data according to the pattern from Block II
Block IV:
Item 01 – second name
Item 02 – the name at borth
Item 03 – nationality
Item 0 4 – sex (”K” – Female,„M” – Male)
Block V:
Code for the title insurance:„24 10 00”
Block VII:
Date of signing the agreement
Block VIII:
Health insurance code: 01R
Block IX:
Your registered address in PL
Block X:
Your residence address in PL
Block XI:
The address for correspondence in PL
Block XII:
Item 01 – the date of completion of the document
Item 02 – the signature