What do you do if you need emergency health care during your temporary stay in another EU/EEA country or Switzerland, for example when you are on holiday, on a business trip or while studying abroad?
Regulations (EC) 883/2004 & 987/2009 – European Health Insurance Card
The EU Regulations (EC) 883/2004 & 987/2009 on the coordination of the social security systems of the EU/EEA member states and Switzerland provide for the use of the European Health Insurance Card (EHIC) for urgent and necessary medical care, also known as unplanned healthcare, when you are travelling for holidays, business or studies.
The European Health Insurance Card (EHIC) entitles you to medically necessary care in an EU/EEA country and Switzerland if you suddenly become ill, have an accident or need treatment due to a chronic illness or pregnancy or childbirth provided that the purpose of your stay in the country is not the medical care or childbirth. By presenting your EHIC to the public health system, the medically necessary care is provided at the same price and on the same terms as the domestic insured persons in the country you are visiting.
Medically necessary care refers to medical care due to a sudden illness or injury during a temporary stay abroad, such as vacation, business trip, family visits or studies. The necessary medical care is provided so that you don’t have to return home before the end of your scheduled stay. The treatment was by no means the original reason for your move and stay abroad.
What you need to know about the use of the EHIC
- The EHIC is issued by your statutory health insurance fund. If, for any reason, your EHIC is not available in time, ask for a Provisional Replacement Certificate (PRC). You will have the same rights as the EHIC.
- The EHIC is not an alternative to travel insurance. It does not cover any private healthcare or costs such as a return flight to your home country.
- The EHIC does not mean free services for patients. Healthcare services you receive free of charge in Greece may be subject to a charge in another country. Patients’ charges for healthcare also vary from country to country.
- Make sure you contact a provider that accepts EHIC and is public or contracted with the public health system of the country you are visiting.
- You are entitled to health benefits provided by the national health insurance system of the state of treatment in similar cases as if you were insured in that state. How to use the European Health Insurance Card (EHIC) in every EE/EEA member state and Switzerland? Find out more here.
- If you are chronically ill and need specific treatment (e.g. chemotherapy, oxygen therapy, hemodialysis) during your temporary stay in an EU country, medical care should be the subject of prior agreement/consultation with the healthcare provider, for practical reasons, to ensure that care is available during your stay in the member state using the EHIC.
- The EHIC does not cover your costs if you are travelling for the express purpose of obtaining medical treatment, also known as planned treatment.
- You are advised to ask for the treatment you receive to be documented and also ask for detailed invoices in the event that you have to pay for the treatment and seek reimbursement later when you return back home.
- In the event that you pay for health care received in a member state EU/EEA or Switzerland that would be covered by EHIC, make sure that you have a doctor’s referral stating the diagnosis and detailed invoices for the health services provided, upon your return to the state of your statutory health insurance. There is a cost search mechanism among the member states and the possibility of being reimbursed with the corresponding amount. For more information, the EOPYY-insured persons in Greece can call: 0030 2108110916, 0030 2108110918 or send an email to: email@example.com.
Directive 2011/24/EU on patients’ rights in cross-border healthcare
In the event that you incurred the healthcare costs yourself for urgent and necessary care in an EU/EEA country and you were not entitled to treatment with the European Health Insurance Card (EHIC), you may claim reimbursement of costs back home. Possible reasons why you were charged could be that you went to a private health care provider or the health services you received are not provided by the statutory health insurance scheme of the country you were visiting. If this is the case, you may be reimbursed by your statutory health insurance back home provided that you have the right to the health services received in your country of insurance. Your right to reimbursement stems from the Directive 2011/24/EU on patients’ rights in cross-border care.
According to the Directive 2011/24/EU, you pay the cost of health services abroad in advance and then claim reimbursement from your national health insurance when you return home. If you are entitled to this health care in the country you are insured, then you will be reimbursed by the competent institution. The reimbursed amount will be equal to the cost of care if it had been provided in your home country. Some types of healthcare, such as hospital care or specialized treatments, may require prior authorization by your national health insurance as a condition of reimbursement of the relevant expenses. Find out more about prior authorization before you decide here.
What you need to know about the Directive 2011/24/EU
- You have the right to seek the expertise of public or private healthcare providers in any EU/EEA member state.
- The range of healthcare benefits that you can seek, is the health benefits that you are entitled to in the country you have statutory health insurance.
- Long-term care, organ transplants and national vaccination programs are excluded from the implementation of Directive 2011/24/EU.
- Specific categories of healthcare, most commonly hospital care and specialized treatments, may require prior authorization by your national health insurance institution. Make sure you are well informed before travelling.
- You have to pay in advance for the treatment that you will receive and seek reimbursement of your expenses when you return home.
- The amount of the reimbursement that you will receive by your health insurance fund will be equal to the reimbursable price for the same kind of treatment if it was delivered at home
- On issues of patient’s safety and quality of treatment, professional liability and complaints in the event of harm, the relevant legislation and regulations of the state of treatment are implemented.
- For further information, you are advised to contact your national contact point for cross-border healthcare.
- Switzerland does not implement the Directive 2011/24/EU.