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The cost of health care services in the EU varies by country. Factors that may affect pricing for the use of healthcare services abroad may include: the country in which you are receiving treatment; whether you have suddenly become ill or had an accident during your stay abroad (emergency care) or have travelled abroad for care (scheduled care); if you are receiving treatment from a public or private healthcare provider; whether an overseas healthcare provider may require an advance payment of all or part of the cost of treatment prior to the provision of care.
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Obligations of healthcare providers in the EU
In EU countries, prices for healthcare treatment must be the same for everyone. Healthcare providers within the EU are free to set their own prices. However, no distinction should be made in pricing between domestic patients and patients seeking treatment from other EU countries.
In EU countries, healthcare providers have to either apply the same healthcare tariffs to patients arriving from other EU countries as to local patients or to charge a price calculated on a non-discriminatory basis if there is no appropriate reference price for local patients.
The healthcare professional provides the patient with an estimate cost for the planned treatment and issues an itemized invoice and proof of payment for the treatment, which can be used as proof of the right to reimbursement by the patient’s statutory health insurance service.
You are advised to contact the healthcare provider in advance to determine how much they will charge for the treatment provided, whether they accept EU certificates of entitlement forms (EHIC, S2) and how payment can be arranged. Make sure you receive a receipt for all your payments and a detailed description of all the procedures performed if they are not mentioned on the receipt.
Costs and reimbursement – Social Security Regulations (EC) 883/2004 & 987/2009
Tariffs applied in the country of treatment
On the display of a valid European Health Insurance Card (unplanned treatment) or S2 form (planned treatment), you will receive treatment at the same terms and at the same price as patients covered under the national statutory health insurance in the country of your stay.
As a result, the reimbursement tariff of the country of treatment will apply.
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Payment method applied in the country of treatment
Also the method of payment will depend on the legislation of the country of treatment.
1) If the treatment you need is free for local residents – In other words, if there is a system of third-party payment in place
- you either do not have to pay anything or you only have to pay the patient’s part of the costs (co-payment)
- costs will be settled directly between the healthcare provider abroad and the national health insurance service of that country. The foreign national health insurance service will then liaise with your own national health insurance at home to obtain refund
2) If you have to pay for the treatment:
- you may ask for reimbursement directly from the local national health service while you are still in the country of your visit. The foreign national health insurance service will then liaise with your own national health insurance service at home to get their money back
- or you may ask for reimbursement from your own national health insurance service upon return home.
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Co-payment
Regardless of which payment procedure applies you will have to bear only the costs of co-payment yourself, that is the patient’s share. The amount of the co-payment will depend on the legislation applied in the country of treatment. As a result, you will pay the same amount as if you were a local patient.
However, in case of planned treatment you may be able to assume all or part of the costs of co-payment. The so-called Vanbraekel supplement will have to be paid by your national health insurance service when the costs incurred by the latter for the treatment abroad are lower than the costs that it would have had to assume in case the same treatment was provided on its own territory. More specifically, when the tariff in your home country is higher than the tariff in the country of treatment, you will be reimbursed up to the amount that would have been assumed given that the treatment was provided at home (without exceeding the actual expenditures you have incurred abroad). Make sure you submit a request for additional reimbursement under the Vanbraekel Supplement when applicable.
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Extra costs for travel and stay
Generally, only medical costs are covered. Extra costs for travel and stay, such as hotel, transport or subsistence costs, as well as those of the person accompanying the patient, are not covered. However, you will be entitled to reimbursement for the extra costs if your statutory health insurance scheme provides accordingly.
We recommend you contact your national health insurance service or National Contact Point for more information on the amount of costs that will be assumed and which costs you will finally have to bear yourself.
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Costs and reimbursement – Directive 2011/24/EU
Tariffs applied in the home country
You will be entitled to reimbursement according to the domestic tariffs applied in case the treatment would not have been provided abroad but in your own Member State. As a result, the tariff of your country of residence/social insurance will apply.
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Upfront payment
You initially pay all medical costs yourself. Subsequently, you may submit a claim for reimbursement with your national health insurance service upon return home. The latter will reimburse you retrospectively according to the rules and rates applied by its own statutory health insurance system. The amount which you are entitled to cannot be higher than the actual costs you have paid for your treatment abroad.
In order to approve your claim for reimbursement, your national health insurance service may require to present all sorts of documents of proof of the exact treatment you have received and the costs you have made. Make sure you check which necessary documents to collect beforehand. Besides, the national health insurance service may require the documents to be translated into the home language. You may possibly have to pay yourself for any translation costs.
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Co-payment
You should be aware that you will only be reimbursed up to the tariff applied in your home country, which may be less than what you paid for the treatment abroad. This may cause you to bear a big part of the medical costs yourself. However also the opposite may occur: the applicable tariffs in your home country may be higher than the tariffs applied in the country of treatment. In case of the latter, it may be possible that you will be fully refunded for your medical costs incurred abroad. Thus, the exact amount of costs you will finally have to bear yourself will fully depend on the reimbursement scheme applied in your home country.
Make sure you ask the healthcare provider abroad to provide itemized invoices for the treatment provided. Generally only the medical costs directly related to the specific treatment may be assumed under Directive 2011/24/EU. Extra costs, such as costs for travel and stay you will have to pay for yourself. Member States may decide, at their discretion, to reimburse other related costs besides medical costs, such as costs for travel and accommodation or extra costs which persons with disabilities might incur when receiving treatment abroad.
Before travelling abroad, always consult with your national health insurance service to collate information on the anticipated costs and reimbursement rates. Try to set out which costs you may expect to finally bear yourself.
Besides, also check beforehand on which institution to address for reimbursement, on the applicable procedures and time limits, and on which necessary documents you will have to provide.
