Expenses and reimbursements: planned medical treatment abroad
Affected by Brexit?
There are two ways to cover the costs of your planned medical treatment in another EU country:
1. Your health insurer can cover all the costs directly:
- This system applies to public health care providers - it does 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 authorisation form (called an S2 form)
- The cost of your medical treatment will be covered by your health insurer according to the reimbursement rates in the country where you're treated.
- Reimbursement will usually be arranged directly between the institutions involved, so you won't have to pay for the treatment.
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 and can apply for 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, both public and private.
- You will be reimbursed up to the amount that specific treatment costs in your home country, but only if you are entitled to that treatment at home.
You might still have to apply for prior authorisation for hospital treatment or highly specialised and expensive treatment - check with your National Contact Point.
Reimbursement without prior authorisation is not applicable in Switzerland.
Sample story 1
You don't always need prior authorisation, but it's better to have it
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 usually be reimbursed directly between the institutions involved. If Hugo has to pay from the treatment himself, he will be reimbursed afterwards in his home country.
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.
Sample story 2
You may need to pay some costs upfront, even with prior authorisation
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:
- the specific treatment you need is not available in your home country, but is covered by your statutory health insurance, and
- you can't get the treatment you need without undue delay in your country, considering your current state of health and the course of your illness
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.