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In some cases, under EU law, you have the right to travel for planned medical treatment, such as a visit to a specialist, surgery or treatment for a specific condition, in another EU/EEA country or Switzerland. Before you leave, make sure you fully understand your rights and the administrative procedures you need to follow.
In case of planned treatment you travel to another EU/EEA country or Switzerland with the explicit purpose of accessing medical treatment. Be aware that treatment will also be considered to be planned when you seek healthcare during your stay abroad, such as holiday, that is not medically necessary and that could be postponed until your return back home.
In many cases in order to be entitled to assumption of costs of the treatment abroad, prior authorisation from your statutory health insurance service in the country under whose social security system you are insured, will be required before travelling abroad.
Two possibilities – different consequences for the patient
As a person insured with an EU-social security system, you are able to benefit from the coverage of planned treatment costs in another EU/EEA country and Switzerland by your statutory health insurance service, both under the Regulations (EC) 883/2004 and 987/2009 on the coordination of social security systems and the Directive 2011/24/EU.
Under EU law, these two possibilities have different consequences for patients in terms of legal basis, scope, competent authorities, approval conditions, reimbursement costs, payment procedure and formalities, as well as the amount of the patient’s own co-payment. Make sure you are always well informed about any financial and other implications.
When applying for prior authorization for cross-border treatment, you have the right to have your claim examined pursuant to the Regulation (EC) 883/2004 and in case the conditions of the Regulation (EC) have not been met, also pursuant to the Directive 2011/24/EU.
Generally, patients should not be deprived of the more beneficial rights guaranteed by the Union Regulations on the coordination of social security systems when the conditions are met. Therefore, any patient who requests an authorisation to receive treatment appropriate to his condition in another Member State should always be granted this authorisation under the conditions provided for in the Union’s regulations when the treatment in question is among the benefits provided for by the legislation in the Member State where the patient resides and when the patient cannot be given such treatment within a time limit that is medically justifiable, taking account of his current state of health and the probable course of the condition. However, if a patient instead explicitly requests to seek treatment under the terms of the Directive 2011/24/EU, the benefits which apply to reimbursement should be limited to those which apply under the Directive. Where the patient is entitled to cross-border healthcare under both the Directive 2011/24/EU and Regulation (EC) No 883/2004, and the application of that Regulation is more advantageous to the patient, the patient’s attention should be drawn to this by the Member State of affiliation.
You may have additional rights to treatment abroad based on the national law or bilateral/multilateral Social Security Agreements of your state of affiliation. We recommend that you contact your statutory health insurance service for further information before you make any final decisions.
You may find useful tips on organizing planned treatment abroad here.
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Prior authorization for planned healthcare under the Regulations (EC) 883/2004 & 987/2009 – the S2 route
Under the Regulations (EC) 883/2004 & 987/2009 for the coordination of the social security systems, as persons affiliated with an EU-social security system, you have the right to travel to any EU/EEA country or Switzerland for the purpose of accessing health care, which is referred to as planned healthcare (Article 20 of Regulation (EC) 883/2004). You always need prior authorization for planned healthcare.
With the approval of the competent statutory health insurance service, the form S2 will be issued. S2 form entitles you to receive treatment abroad on the same terms and at the same cost as those insured in the public health system of the state of treatment. Your statutory health insurance service will assume the costs for the treatment abroad according to the tariffs in force in the country of treatment. Doctors’ fees that are not covered by the S2 forms, as well as any patient co-payment, provided by the domestic legislation of the country where you receive care, may not be covered by your statutory health insurance service.
Keep in mind!
- The Social Security Regulations (EC) 883/2004 & 987/2009 are implemented in the EU/EEA member states (27 EU member states + Iceland, Liechtenstein, Norway) and Switzerland.
- You’ll always need authorization for planned treatment.
- The S2 form gives you access to healthcare professionals that are public or contracted with the public healthcare system in the state of treatment.
- There is a reimbursement mechanism of the costs for health benefits in kind among member states. Remember that doctors’ fees that are not covered by the S2 form, or any patient’s co-payment, prescribed by national law of the state of treatment, may not be reimbursed by your statutory health insurance service.
- Pursuant to national law in Greece, the statutory health insurance service may assume additional costs such as travel and accommodation expenses for the patient and one necessary escorting party.
- Your entitlement to sickness benefits in kind in the country of the treatment is limited to the total benefits provided by the country’s public health insurance system.
Prior authorization (S2 form)
To be eligible for assumption of healthcare costs pursuant to the Social Security Regulations (EC) 883/2004 and 987/2009, you will always need prior authorization by your statutory health insurance service.
If prior authorization is granted, your statutory health insurance service issues an S2 form. The S2 form proves to the state of treatment that you wish to receive care as an insured person in the public health system of that state and that your statutory health insurance service will assume the payment of the costs incurred.
Useful information
The following situations of planned healthcare abroad are not covered under the Social Security Regulations (EC) 883/2004 and 987/2009:
- treatment provided by a private healthcare provider or in a private hospital with the exception of private healthcare providers/hospitals that are contracted or affiliated with the public health insurance scheme of the state of treatment,
- telemedicine services as the Regulations expressly require the physical movement and presence of the patient in the country of treatment, where the healthcare provider is located.
More questions?
If you have further questions, contact your statutory health insurance service or the national contact point for cross-border healthcare.
Prior authorization for planned treatment under the Directive 2011/24/EU
Further to having access to planned healthcare abroad under the Social Security Regulations (EC) 883/2004 and 987/2009, EU/EEA insured persons also have the right to access planned healthcare in any EU/EEA member state under the Directive 2011/24/EU. However, cross-border healthcare in Switzerland is excluded from the Directive 2011/24/EU route.
So when you want to access planned healthcare abroad, you will have two different options. Although you are entitled to treatment with both routes, you should always be aware of the different consequences.
Under the Directive 2011/24/EU on patients’ rights in cross-border healthcare you are entitled to assumption of costs for treatment abroad as though the treatment was provided in your home country.
You initially pay all medical costs upfront. Upon your return home you may file for reimbursement with your statutory health insurance service. They will reimburse you according to the domestic tariffs applied for the same treatment at home.
For certain treatments, you may need prior authorization.
Keep in mind!
- Long-term care, organ transplants and national vaccination programs are excluded from the implementation of the Directive 2011/24/EU.
- Prior authorization may be required for some types of care. Make sure you know before you travel.
- You have the right to access a public or private healthcare provider.
- The range of health benefits you can seek is all the health benefits you are entitled to in the country where you are insured.
- The Directive 2011/24/EU does not apply in the case of healthcare in Switzerland.
- You will have to pay for the care you will receive and seek reimbursement of your expenses when you return back home.
- The amount of reimbursement you will receive from your statutory health insurance service will be equal to the price paid for the same type of care if it was provided at home.
- You will have to bear the translation costs of the necessary supporting documents.
Prior authorization
Under the Directive 2011/24/EU, prior authorization is required for certain categories of care:
hospital treatment with at least one overnight stay
Specifically, national law in Greece prescribes that EOPYY-insured persons need to seek prior authorization for inpatient hospital care which is remunerated on the basis of KEN (equivalent to DRG system). More information on the KEN/DRG lists, remuneration rates and related average hospitalization duration can be found here.
care that requires the use of highly specialized and expensive medical infrastructure or medical equipment
A detailed list of special treatments, examinations and operations requiring prior authorization in Greece, irrelevant of hospitalization days, follows:
- implantation of cardiac support devices (ICS), biological aortic valves, non-surgical implantation of endocardial damage correction devices.
- placement or replacement of defibrillators/pacemakers to prevent/reduce atrial arrhythmias,
- implantable systems (electrical stimulation or spinal cord, brain and Vagus nerve – neuro-muscular stimulation – programmed administration of purified morphine and Baclofen – temporary implants for brain mapping,
- gastric ring procedure and stomach compartmentalization,
- stereotactic radio surgery (Gamma-Knife, x-Knife and Cyberknife),
- hearing restoration implants (eg cochlear implants),
- PET / CT positron emission tomography and computed tomography
- in vitro fertilization (IVF- medically assisted reproduction).
Your statutory health insurance service may refuse to grant prior authorization under the Directive 2011/24/EU for specific reasons, when:
- the patient, according to a clinical assessment, will be exposed with reasonable certainty to a risk for his safety, which can’t be considered acceptable, taking into account the potential benefit to the patient of the intended cross-border health care,
- the general public will be reasonably exposed to a significant safety risk as a result of this cross-border healthcare,
- such healthcare is to be provided by healthcare providers who have serious and specific concerns about the quality of care and patient safety,
- this healthcare can be provided domestically within a medically acceptable period, taking into account the patient’s state of health and the possible progression of his disease.
Useful information
- Before traveling abroad, always be sure to check with your statutory health insurance service about prior authorization requirement and procedures.
- You can request a prior notification with the estimated amount to be reimbursed based on the provisions of the Health Benefits Regulation of your statutory health insurance service.
- Find out about the documentation you will need to provide after your return back home, in order to be reimbursed for the care you received abroad.
- Request a detailed record of the care you received and a copy of your medical record from the care provider abroad, so that care can continue after your return home.
- Be aware that healthcare providers in all EU/EEA countries must provide relevant information to help you make informed choices, including treatment options, availability, quality and safety of the healthcare they provide.
- Be aware that healthcare providers in all EU/EEA countries must issue detailed invoices and provide you, upon request, with clear pricing information, as well as their license or registration status, their insurance coverage or other means of individual or collective protection as regards their professional liability, in accordance with the national law of the state of care.
- Keep in mind that in matters of quality and safety of care, professional liability and complaints procedure in the event of damage, the relevant laws and regulations of the state of treatment apply.
More questions?
If you have further questions, contact your statutory health insurance service or the national contact point for cross-border healthcare.
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