Updated : 12/10/2017
There are two ways to cover the costs of your planned medical treatment in another EU country:
If you're being treated in a country where patients usually pay for treatment and are reimbursed by their health insurer afterwards, you may have to pay some costs upfront. You can then ask for reimbursement from the relevant authority in the country where you are treated. They will reimburse you directly at the same rate as people insured in that country.
You can also choose to ask your insurer to reimburse you when you get back home. If the reimbursement rate for the treatment you received abroad is higher in the country where you are insured, you are entitled to a supplementary reimbursement from your health insurer to cover the difference.
You might still have to apply for prior authorisation for hospital treatment or highly specialised and expensive treatement - check with your National Contact Point.
Reimbursement without prior authorisation is not applicable in Switzerland.
Hugo wants to have treatment for cataracts (which is covered by his health insurance) in Germany. However, the treatment costs more in Germany than it does in his home country. Hugo wants the full cost to be covered, so he must apply to his health insurer for prior authorisation. If he gets the authorisation, he can go abroad and have the treatment, and the full cost should be reimbursed directly between the institutions involved.
Yvonne wants to receive the same cataract treatment, again in Germany, and once again it is normally covered by her health insurer. She wants to get the treatment as soon as possible. Yvonne checks with the National Contact Point in her home country to see if she has to apply for prior authorisation and finds that she doesn't have to do so. She therefore goes abroad and gets the treatment. Yvonne pays for the treatment herself and claims back some reimbursement from her health insurer when she gets home. As she didn't get prior authorisation and the treatment cost slightly more in Germany, Yvonne has to pay some of the costs herself. Without prior authorisation, her health insurer only reimburses up to the rate set in her home country.
Agata wants to get her complex surgery performed in Finland at a hospital which is part of the public health system. As this surgery is subject to prior authorisation under either the direct payment or reimbursement routes, she applies for prior authorisation and, if authorised, gets the cost covered directly.
Bernard wants the same surgery, also in Finland, but at a private hospital. In this case he must still apply for prior authorisation, but the direct payment option doesn't apply. If he gets prior authorisation, Bernard has to pay the cost of surgery and then claim reimbursement. He should receive reimbursement up to the level applied in his home country for the same kind of surgery.
Whichever option you choose, your health insurer cannot refuse your request for prior authorisation if:
You can find out more about relevant costs and reimbursements either directly from the healthcare provider or from the National Contact Point in the EU country where you want to be treated.