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Updated : 02/10/2014

health

Planned healthcare: expenses and reimbursements

There are two ways to cover the costs:

1. Your health insurer can cover all the cost directly.

  • This system applies to public health care providers - it may not cover private treatment.
  • You must ask your insurer for prior authorisation before travelling for treatment. If granted, you will then be provided with the appropriate application form (called an S2 form)
  • The full cost of your treatment will be covered by your insurer.
  • Reimbursement will usually be arranged directly between the institutions involved so you won't have to pay for the treatment.

However, if you are being treated in a country where patients usually pay for treatment and are then reimbursed by their health insurer, you may have to first bear some costs. You should then seek reimbursement from the authorities in the country where you are treated. They will reimburse you directly at the same rates as local residents. Alternatively, you can ask your insurer for the reimbursement 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.

2. You can pay for the treatment yourself and claim reimbursement afterwards:

  • This option covers all providers, whether public or private.
  • You will be reimbursed up to the cost of that treatment in your home country, but only if that treatment is one you are entitled to at home.

You might still have to apply for prior authorisation - check with your National Contact Point.

Sample story 1

Xavier wants to receive regular dental treatment (which is covered by his health insurance) in Member State Y. However the cost of that treatment in the other Member State is higher than the cost at home. Xavier wants the full cost to be covered, so must apply to his insurer for prior authorisation. Once he receives it he can go abroad and get the treatment without having to pay upfront as the full cost will usually be reimbursed directly between the institutions involved.

Yvonne wants to receive the same dental treatment, again in Member State X. She wants to get the treatment as soon as possible. Yvonne checks with the National Contact Point to see if she still 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 herself and claims back some reimbursement on her return.

Sample story 2

Agata wants to get her complex surgery performed in Member State Y by a provider contracted to the public health system. Since this surgery is subject to prior authorisation under either the direct payment or reimbursement routes, she applies for prior authorisation and either gets the cost covered directly by the institution or claims the reimbursement when she gets back home.

Bernard wants the same surgery, also in Member State Y, but from a private provider. In this case he must still apply for authorisation, but the direct payment option does not apply. Bernard must pay the cost of treatment and then claim reimbursement. He will usually receive it up to the level applied in his home country for the same kind of treatment.

Whichever option you choose, your health insurer cannot refuse your request for prior authorisation if:

  • the specific treatment you need is not available in your home country, but is covered by your statutory health insurer, and
  • you can't get the treatment you need without undue delay in your country.

You can find out more about relevant costs and reimbursements either directly from the healthcare provider or from the National Contact Point of the EU country where you want to be treated.

Useful national addresses and websites:

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