Expenses and reimbursements: planned medical treatment abroad
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 always 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 the costs of the treatment yourself. 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.
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 treatment requiring an overnight hospital stay or highly specialised and expensive medical infrastructure - check with your health insurer or your National Contact Point. You can also find links to lists of treatments subject to prior authorisation in your country here.
With this option, you might be treated as a private patient and charged private prices in another EU country even in public establishments. The reimbursement to you will always be at the level of public prices, thus, you will have to bear the difference.
Warning
Reimbursement without an S2 form is not applicable in Switzerland.
Sample story 1
You don't always need prior authorisation, but the costs will differ
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 (S2 form). If he gets the authorisation, he can go abroad and have the treatment, and the full cost should usually be covered directly between the institutions involved. However, his health insurer can refuse to issue the S2 form, if the treatment could be provided to Hugo in his home country within a medically justifiable time limit.
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, as the treatment does not involve an overnight stay in a hospital nor highly specialised and expensive medical infrastructure. She therefore goes abroad and gets the treatment in a private clinic. Yvonne pays for the treatment herself and claims back some reimbursement from her health insurer when she gets home. Without a S2 form, her health insurer only reimburses up to the public rate set in her home country. Thus, Yvonne has to bear the difference between the price she paid to the private clinic in Germany and the reimbursement rate 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. This surgery is subject to prior authorisation from her home country. Thus, Agata applies for prior authorisation (a S2 form) and, if authorised, gets the treatment 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 coverage option doesn't apply to private healthcare. 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 and bear the difference between the treatment price and the reimbursement tariff.
Whichever option you choose, your health insurer cannot refuse your request for prior authorisation if:
- the specific treatment you need 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 expenses and reimbursements either directly from your health insurance institution or from the National Contact Point in the EU country where you are insured.