In Greece, the major statutory health insurance organization is EOPYY (National Organization for the Provision of Health Services) covering over 95% of the population. EOPYY was established in 2011 to manage a single unified health insurance fund and to act as the sole purchaser for publicly funded health services delivered by the National Health System.
EOPYY provides for health services on the basis of a Unified Health Benefits Regulation. The health services included in the health benefits package are provided by a network of public healthcare providers (PEDY-primary care networks and ESY-hospitals) and EOPYY-contracted private healthcare providers. There is a system of third-party payment in place with regulated patient’s co-payments for certain health services.
Health services remuneration and co-payments
For health benefits in kind under the Unified Health Benefits Regulation (EKPY), EOPYY reimburses the contracted parties as follows:
- According to a contract concluded by the two parties, which results from a negotiation process with the EOPYY-Negotiation Committee and is ratified by the EOPYY-Administrative Board or,
- Based on the insurance price, which is determined either by decisions of the Minister of Health, following proposals of EOPYY-Administrative Board, or by decisions of the EOPYY-Administrative Board, following proposals of the EOPYY-Negotiations Committee
- With the prices provided by the state tariffs list, in cases where no insurance price has been set. In any case, the reimbursement price may not exceed the amount provided each time by the state tariffs list, unless explicitly provided in EKPY.
EOPYY-insured persons are directly reimbursed only in case of proven inability to contract with a category of providers or lack of contractual agreements for certain health services.
The amount of the patient’s co-payment depends on the type of health service (pharmaceuticals, hospital care, diagnostics etc) and the affiliation of the healthcare provider with EOPYY (public or EOPYY-contracted). The co-payment for every health service is regulated and specified in EKPY.
Insured persons, when receiving health services or hospital care in EOPYY-contracted private healthcare providers, are not obliged to any additional financial burden, other than those provided by EKPY.
Healthcare provided in public health facilities, either PEDY-primary care networks or ESY-hospitals, has no patient’s co-payment requirement for the EOPYY-health benefits package. However, there is a co-payment requirement if the patient receives health services from EOPYY-contracted healthcare providers.
EOPYY- Reimbursement tariffs
EOPYY publicizes the health benefits package, the reimbursement tariffs for health services and the EOPYY-contracted health professionals per region and health service on the Organization’s website, using e-tools. More information is available here.
Hospital inpatient care is reimbursed on the basis of KENs (equivalent to international Diagnostic–related Groups – DRGs). The KEN-list with the respective reimbursement amounts is available here. For hospital inpatient treatments that are not included in the KEN-list, EOPYY reimburses with a daily hospitalization fee which is defined by Ministerial Act. Additionally, the Unified Health Benefits Regulations (EKPY) defines a list of pharmaceuticals, medical products and materials as well as medical acts that are reimbursed extra further to the KEN (or daily hospitalization fee) tariffs.
Travel and accommodation expenses for treatment abroad
As an EOPYY-insured person, you may or may not expect the coverage of additional costs when seeking healthcare abroad in the following situations:
- If you have been treated in an EU/EEA country or Switzerland using the European Health Insurance Card (EHIC), you are not entitled to travel, repatriation or accommodation expenses abroad.
- If you have been treated in a non-EU country due to a sudden illness or accident, you are not entitled to travel and accommodation expenses.
- In case you have received authorization for planned treatment abroad, travel expenses for the patient and an escort (if an escort has been approved) may be covered. In addition, a fixed daily subsistence allowance for accommodation and food may be provided.