Spa treatment (leczenie uzdrowiskowe) is an important form of healthcare available to people covered by Poland's universal health insurance system. For employees using this type of care, the key issue is what rights they have while absent from work because of a stay at a spa. Knowing the detailed legal rules helps you plan your treatment properly and protect your rights as an employee.
The Polish spa treatment system offers several ways to use specialist medical care. Employees can obtain a referral for spa treatment funded by the National Health Fund (NFZ – Narodowy Fundusz Zdrowia) or take part in medical rehabilitation organised by ZUS (Social Insurance Institution) as part of disability prevention (prewencja rentowa). Each of these options has different consequences for the employment relationship and for employee rights.
Spa treatment means an organised activity consisting in providing healthcare services in the field of spa treatment or spa rehabilitation. It is carried out in a spa resort by spa treatment facilities using natural conditions, such as the properties of natural medicinal resources and the medicinal properties of the climate
Because spa treatment takes various forms, both employees and employers need a good understanding of the rules governing rights during absence from work. Applying the rules incorrectly can lead to problems with paying salary, protection against dismissal or calculating sickness benefits.
Spa treatment in Poland – an overview
Spa treatment in Poland is governed by the Act of 28 July 2005 on spa treatment, spa resorts, spa protection areas and spa municipalities. The Act precisely defines the scope of medical activity carried out in spa resorts and sets out the conditions for providing healthcare services.
Under the statutory definition, spa treatment is characterised by the use of the natural healing properties of the environment. This covers above all the properties of natural medicinal resources, the medicinal properties of the climate, including thalassotherapy and subterraneotherapy, and the medicinal properties of the microclimate. In addition, accompanying physiotherapy treatments are used as part of spa treatment.
Spa treatment facilities are spa hospitals, spa sanatoriums, spa hospitals for children and spa sanatoriums for children, spa outpatient clinics, natural therapy centres, and hospitals and sanatoriums in adapted underground mine workings
Healthcare services in spa treatment facilities are provided on the basis of medical documents issued by an authorised doctor. Under Article 14 of the Act, the basis for treatment is a referral for spa treatment or spa rehabilitation, or a certificate confirming that there are no contraindications to using a given type of healthcare service in a given spa resort.
The Polish spa treatment system includes various forms of therapy adapted to individual patients' needs. Treatment can take place on an outpatient basis in spa clinics or as inpatient treatment in spa hospitals and sanatoriums. Each of these forms requires proper medical documentation and meeting specific medical criteria.
Another feature of the Polish system is the possibility of therapy in adapted underground mine workings. This unique form of treatment uses the special microclimate of underground facilities, which may be particularly beneficial for people with certain respiratory conditions.
Spa treatment funded by the NFZ
Spa treatment funded by the National Health Fund is one of the basic forms of medical rehabilitation available to beneficiaries. The rules in this area are set out in the Act of 27 August 2004 on healthcare services financed from public funds, known as the Health Care Act.
Under Article 33 of the Health Care Act, spa treatment or spa rehabilitation is available to a beneficiary on the basis of a referral issued by a health insurance doctor. The referral must be confirmed by the National Health Fund, and the provisions of the Code of Administrative Procedure do not apply to confirming or refusing to confirm the referral.
NFZ spa treatment is a continuation of hospital or outpatient treatment. Only people who are sufficiently fit, able to travel to the spa on their own and take part in the treatments, can be referred for it
For adults treated as inpatients, NFZ-funded spa treatment lasts from 21 to 28 days, depending on the type of services provided (21 days for spa treatment, 28 days for spa rehabilitation; outpatient treatment from 6 to 18 days). This relatively long period of therapy requires proper planning by both the patient and the employer, especially in terms of work organisation and cover.
A beneficiary referred for NFZ spa treatment bears certain costs of the therapy. These include the cost of travel to and from the spa and partial payment for meals and accommodation in the spa sanatorium. The entity obliged to finance healthcare services from public funds covers the difference in the cost of the insured person's meals and accommodation, up to the amount set in the contract with the spa sanatorium.
A key issue for employees using NFZ spa treatment is that they have no automatic right to sick leave. Sickness benefit is paid for incapacity for work due to illness (Article 6(1) of the Sickness Benefits Act – ustawa zasiłkowa), and a stay in a sanatorium is not one of the situations treated in the same way as such incapacity (Article 6(2)). There is therefore no basis for issuing sick leave to a beneficiary for the time of a sanatorium stay if no incapacity for work due to illness has been found. When the employer pays for the stay, the next question is ZUS contributions on a sanatorium subsidy.
How to get leave for NFZ spa treatment
An employee planning a sanatorium stay as part of NFZ-funded spa treatment must take certain steps to protect their legal position during the absence from work. The basic requirement is to obtain the employer's consent to annual leave (urlop wypoczynkowy) or unpaid leave (urlop bezpłatny).
The employer has no statutory obligation to grant leave specifically for the dates of the sanatorium stay – the dates of annual leave follow from the leave schedule or an agreement with the employee (Article 163 of the Labour Code – Kodeks pracy), and granting unpaid leave is at the employer's discretion (Article 174 § 1). The exception is leave on demand (urlop na żądanie) – up to 4 days per calendar year on dates chosen by the employee (Article 167(2)). The employee should submit a leave request well in advance, presenting documents confirming the referral for spa treatment. It is also worth giving the employer information about the planned dates and length of the therapy.
- Obtaining a referral for spa treatment from a health insurance doctor
- Confirmation of the referral by the National Health Fund
- Receiving information about the date and place of treatment
- Submitting a request for annual or unpaid leave to the employer
- Obtaining the employer's written consent to the absence from work
- Arranging cover and handing over work duties
- Completing the spa treatment in line with medical recommendations
If the employer grants the employee annual leave in connection with spa treatment, the employee is entitled to remuneration determined under the Labour Code and to protection against termination of the employment contract with notice under Article 41 of the Labour Code
If the employer agrees to annual leave, the employee keeps all rights arising from the employment relationship. This means the right to remuneration calculated under the Labour Code and protection against termination of the employment contract with notice. This protection follows from Article 41 of the Labour Code, which prohibits giving notice during the employee's leave, and covers the period of the employee's absence.
The alternative to annual leave is unpaid leave, which also requires the employer's consent. In this case the employee receives no remuneration for the absence but keeps the continuity of the employment relationship. However, the period of unpaid leave does not count towards the period of employment on which employee rights depend (Article 174 § 2 of the Labour Code), and no sickness benefit is paid for illness falling during unpaid leave (Article 12(2)(1) of the Sickness Benefits Act). Unpaid leave may be a solution when the employee does not have enough days of annual leave.
Planning NFZ spa treatment also requires taking into account the organisational aspects of running the workplace. The employer may need time to arrange cover or move project deadlines. That is why the leave request should be submitted well in advance, so that the employer can properly prepare for the employee's absence.
Medical rehabilitation as part of ZUS disability prevention
ZUS carries out tasks in the field of disability prevention, which is an alternative form of spa-type treatment for certain groups of insured persons. The legal basis for this activity is the Act of 13 October 1998 on the social insurance system, known as the System Act (ustawa systemowa).
Under Article 69(1)(1) of the System Act, the scope of ZUS's activity includes disability prevention covering medical rehabilitation of insured persons at risk of total or partial incapacity for work, people entitled to sickness benefit or rehabilitation benefit after their sickness or accident insurance has ended, and people receiving a temporary disability pension.
Medical rehabilitation as part of ZUS disability prevention is available to insured persons (including employees) at risk of total or partial incapacity for work, to people entitled to sickness benefit or rehabilitation benefit after their insurance has ended, and to people receiving a temporary disability pension. ZUS refers these insured persons to rehabilitation centres
The procedure for referral to medical rehabilitation is set out in the Regulation of the Council of Ministers of 12 October 2001 on the detailed rules and procedure for referral by the Social Insurance Institution to medical rehabilitation and for awarding contracts for rehabilitation services.
The need for medical rehabilitation is decided by a ZUS certifying doctor (lekarz orzecznik), while the application for rehabilitation is prepared by the doctor treating the person. It is best to prepare the application on form PR-4, available on the ZUS website. The entitled person submits the application to the ZUS local unit competent for their place of residence.
The ZUS certifying doctor may ask the doctor who prepared the application to provide the entitled person's medical records or to give explanations and information on the case. An objection (sprzeciw) to the ZUS medical board may be lodged against the certifying doctor's decision, within the time limit and under the rules set out in the Act of 17 December 1998 on pensions from the Social Insurance Fund.
How the need for medical rehabilitation is assessed
Assessing the need for medical rehabilitation as part of ZUS disability prevention follows a detailed procedure designed to objectively evaluate the insured person's health and their chances of regaining the ability to work. A ZUS certifying doctor or the ZUS medical board may decide on the need for medical rehabilitation when ruling on incapacity for work for pension purposes or on circumstances justifying the award of rehabilitation benefit.
A ZUS certifying doctor may also decide on the need for medical rehabilitation while checking whether temporary incapacity for work due to illness was correctly certified and sick notes were properly issued. This power allows a comprehensive assessment of the insured person's health and a decision on the most appropriate form of medical support.
| Procedure stage | Responsible | Basis in the regulation | Documents |
|---|---|---|---|
| Submitting the application | Insured person (application prepared by the treating doctor) | § 2(1)–(2) | Form PR-4 |
| Assessing the application | ZUS certifying doctor | § 2(3), § 4 | Medical records |
| Decision | ZUS certifying doctor | § 2(1), § 4(1) | Decision on the need for rehabilitation |
| Referral | ZUS unit | § 5(2) | Notice |
The regulation does not set time limits for the individual stages.
The decision on the need for medical rehabilitation is the basis for ZUS to refer the person to medical rehabilitation. The competent local ZUS unit sends the entitled person a notice of referral to medical rehabilitation. The notice contains detailed information about the place, dates and length of the rehabilitation.
Under § 7(1) of the regulation, medical rehabilitation in a rehabilitation centre should last 24 days. However, the head physician (ordynator) of the rehabilitation centre may extend or shorten it in specific cases, after first obtaining ZUS's consent.
The rehabilitation may be extended or shortened if there is a positive prognosis that the entitled person will regain the ability to work over the extended rehabilitation period, if the entitled person's ability to work is restored earlier, or if there are other reasons on the part of the entitled person
During rehabilitation the employee is on sick leave issued by an authorised doctor. The medical certificate is the basis for excusing the absence from work and for calculating the relevant sickness benefits. This form of treatment differs fundamentally from NFZ spa treatment, where sick leave is not issued automatically.
Employee rights during ZUS rehabilitation
An employee referred to a rehabilitation centre as part of ZUS disability prevention has a wide range of rights under labour and social insurance law. These rights are intended to protect the employee's financial and legal position during the absence from work related to treatment.
The basic right is the right to sickness benefit (zasiłek chorobowy), as a rule at 80% of the benefit base (Article 11(1) of the Sickness Benefits Act; 100% among others during pregnancy – Article 11(2)). This benefit is paid for the whole period of medical rehabilitation on the basis of a medical certificate issued by an authorised doctor of the rehabilitation centre. The amount of the benefit is calculated under the rules on sickness benefits. The deadline and method for passing on the certificate are covered in our article on delivering a sick note to your employer.
- The right to sickness benefit at 80% of the benefit base
- Excused absence from work for the whole period of rehabilitation
- Protection against termination with notice under Article 41 of the Labour Code
- Continuity of social and health insurance
- The right to return to the previous position after rehabilitation ends
- The possibility of extending or shortening rehabilitation at the doctor's request
- Reimbursement of travel costs to the rehabilitation centre by the cheapest means of public transport (§ 8 of the regulation)
The employee's absence from work is excused for the whole period of medical rehabilitation. This happens automatically and requires no additional formalities from the employee other than giving the employer the medical certificate of temporary incapacity for work.
An employee referred to a rehabilitation centre as part of ZUS disability prevention is protected against termination of the employment contract with notice under Article 41 of the Labour Code. This protection covers the period of excused absence from work until the period entitling the employer to terminate the contract without notice has passed (Article 53 of the Labour Code), and does not continue after the return to work
Protection against termination with notice under Article 41 of the Labour Code is particularly important. It covers the rehabilitation period as an excused absence from work, but not the time after it ends. The employer cannot give notice of termination to an employee who is on medical rehabilitation, which gives the employee job stability during treatment.
Continuity of insurance means that during rehabilitation the employee remains in the employment relationship and does not lose the basis for insurance. However, no pension and disability insurance contributions are paid on sickness benefit – the period of receiving it is a non-contributory period (Article 7(1)(b) of the Act on pensions from the Social Insurance Fund).
An employee of a manufacturing company was referred by ZUS for medical rehabilitation because of spinal problems caused by many years of physical work. During a 24-day stay at the rehabilitation centre he received sickness benefit of 80% of his pay, was protected against termination of his contract with notice and, after returning, went back to his previous position, with the possibility of adapting his duties to his current state of health.
Differences between NFZ treatment and ZUS rehabilitation
Understanding the differences between NFZ-funded spa treatment and medical rehabilitation as part of ZUS disability prevention is crucial for employees planning to use these services. Each form has different procedures, rights and consequences for the employment relationship.
The basic difference concerns the eligibility criteria. NFZ spa treatment is available to all beneficiaries on the basis of a referral from a health insurance doctor, provided the NFZ confirms it. ZUS medical rehabilitation, on the other hand, is aimed at people at risk of total or partial incapacity for work who meet specific medical criteria.
Another important difference concerns employee rights during the absence from work. For NFZ treatment, the employee must obtain the employer's consent to annual or unpaid leave, as there is no automatic right to sick leave. ZUS rehabilitation automatically comes with sick leave and the right to sickness benefit. We settle sickness benefits and staff absences for businesses that have entrusted us with their HR and payroll.
| Aspect | NFZ treatment | ZUS rehabilitation |
|---|---|---|
| Sick leave | No automatic right | Issued automatically |
| Pay | Annual/unpaid leave | Sickness benefit 80% |
| Protection against dismissal | No notice during leave (Art. 41 of the Labour Code) | No notice during absence (Art. 41 of the Labour Code) |
| Duration | 21-28 days | 24 days (can be changed) |
The funding of the two forms of treatment also differs significantly. NFZ treatment requires the patient to pay for travel and part of the cost of meals and accommodation. The cost of ZUS rehabilitation, including accommodation and meals, is borne by ZUS, and the patient is reimbursed travel costs by the cheapest means of public transport (§ 8 of the regulation).
The length of treatment differs between the two forms. NFZ treatment may last from 21 to 28 days depending on the type of services, while ZUS rehabilitation normally lasts 24 days and may be extended or shortened by the head physician of the centre after obtaining ZUS's consent
The eligibility procedures also differ considerably. A referral for NFZ treatment must be confirmed by the National Health Fund, but the Code of Administrative Procedure does not apply here. ZUS rehabilitation requires a decision by a ZUS certifying doctor on the need for rehabilitation, against which an objection to the medical board may be lodged.
The differences also concern the nature of the treatment. NFZ treatment is a continuation of hospital or outpatient treatment and is intended for people who are fit enough to manage on their own at the spa. ZUS rehabilitation is preventive in nature and is intended for people at risk of incapacity for work.
Practical aspects of planning spa treatment
Planning spa treatment requires taking into account many practical aspects that may affect the course of therapy and the employee's professional situation. Proper preparation for the absence from work and completing all legal formalities are key to the smooth course of treatment.
The first step should be to obtain detailed information from the treating doctor about the expected length of treatment, its nature and the expected therapeutic effects. This information will help you properly plan your absence from work and prepare the relevant documents for your employer.
For NFZ treatment you need to agree in advance with your employer whether you can take leave. It is worth giving the employer full medical documentation and explaining the importance of the treatment for your health and future ability to work. This may increase the chances of getting annual leave rather than unpaid leave.
- Consulting the treating doctor and obtaining detailed information about the treatment
- Analysing the available treatment options (NFZ vs ZUS rehabilitation) and their consequences
- Preparing the complete medical documentation required for the referral
- Agreeing with the employer on the possibility of taking leave (for NFZ)
- Submitting the application for a referral to the relevant institution (NFZ or ZUS)
- Waiting for confirmation and information about the treatment dates
- Final arrangements with the employer and handing over work duties
- Preparing for the trip and completing the treatment in line with recommendations
Employees should remember to plan spa treatment in advance, especially in the case of the NFZ, where the employer's consent to leave is required. ZUS rehabilitation gives greater legal certainty but requires meeting specific medical criteria
Arranging cover at work is also an important part of planning. The employee should make sure their duties are properly handed over, prepare the necessary documents for the person covering for them and agree how to get in touch in urgent work matters. This approach builds the employer's trust and makes it easier to get consent to the absence.
The financial side of treatment also requires advance planning. For NFZ treatment you need to set aside money for travel costs and partial payment for meals and accommodation. ZUS rehabilitation comes with sickness benefit, but at a lower level than full pay.
It is also worth considering additional health insurance or private healthcare plans, which may offer alternative forms of spa treatment. Such solutions may provide more flexibility in planning treatment and fewer limitations related to administrative procedures.
