14 teams compete in the league, with the top 6 teams at the end of the regular season play qualifying for the playoffs to determine the league champion, known as the Česká pojišťovna play-off Tipsport extraligy. The teams that finish 7th through 10th play a play-in series (best-of-five) to determine who will join the top six into the playoff quarter-finals (best-of-seven). The four lowest ranked teams (11–14) after the regular season play in a play-out group (12 games, all regular-season matches are counted into the ranking). The last-place team after the play-out group plays with the winner of the First League playoff series (best-of-seven), with the winner of that series being qualified to play in Extraliga the following season while the losing team plays in the First League.
Since the 2006-07 season, 3 points have been awarded for a regulation win and 2 points for an overtime victory, while the defeated team in overtime gets 1 point. If necessary, penalty shots are used to decide games after overtime.
From the 2006-07 season through the 2007-08 season there was only one assist credited for each goal instead of the standard two that other leagues credit. This rule change affected league statistics in a negative manner, and so the rule was changed back to the standard two assists starting in the 2008-09 season.
During the 2011-12 season the association of Czech Extraliga managers attempted to close the league to prevent any relegations to or promoting from the second tier national league and also set a maximum salary cap similarly to the NHL system.  However, after some legal difficulties and strong opposition by the public the whole proposition was scratched.