Travelling abroad and need urgent treatment on the spot? Or are you travelling abroad just for medical care? We’ll explain how to get reimbursed for healthcare provided abroad.
Urgent/emergency healthcare
If urgent care is needed while abroad (anywhere, not just in the EU), the insured person must pay for it himself and then ask his insurer to reimburse the costs. The insurer will only reimburse the costs up to the amount set for reimbursement of such services if they were provided in the Czech Republic. The insured will not be entitled to reimbursement for services not covered in the Czech Republic.
However, within the European Union (including EEA countries and Switzerland), there are special arrangements under the so-called EU coordination regulations. A European insured person is entitled to the care he or she needs for his or her illness to avoid having to leave the country sooner than planned (essential care), under the same conditions as a local insured person. In this case, the care is paid for by the local health insurer up to the amount it would have paid for the insured person. In these cases, the care may also be care that is not covered in the Czech Republic – if it is essential care, the insured person in another Member State has the same right to receive it as the local insured person. If the healthcare facility requests cash reimbursement from the insured person, the insured person has the right to reimbursement from his/her health insurer. It is therefore worthwhile to always carry your insurance card with you.
Planned care in the EU – without prior authorisation from the insurer – cross-border care
These are cases where the patient travels abroad specifically for medical care, which may not be essential. If the patient does not have the prior approval of the insurance company, he or she must pay for the care himself or herself on the spot and then subsequently claim reimbursement from the health insurance company. However, this must be care that is covered by public health insurance in the Czech Republic. The health insurer will only reimburse the amount it would have spent on the same care in the Czech Republic (up to the amount the insured person actually paid for the care). This scheme applies only to EU Member States.
Planned care in the EU – with prior approval from your insurer
The insured person has the possibility to ask the insurance company for consent before travelling abroad (or before receiving planned care abroad). Such consent must be accompanied by a statement from the referring doctor in the Czech Republic or other documents required by the insurance company. The care must be provided in healthcare facilities connected to the public health insurance system. It will be reimbursed by the insurance company according to the conditions of the country of residence and the insured person pays the deductible and fees in the same way as local insured persons.
The insurer must agree to reimbursement if the health services are
they are covered by Czech public health insurance (treatment that insured persons in the Czech Republic have to pay for is not covered) and
cannot be provided in the Czech Republic within a medically justifiable time
e.g. the waiting time in the Czech Republic would exceed an acceptable time based on an objective medical assessment of the patient’s needs when evaluating his/her health condition at the time of application
In other cases, the insurance company does not have to give its consent.
Care that is the only option in terms of the patient’s health (so-called § 16)
In exceptional cases, the health insurer covers health services not otherwise covered by health insurance if the provision of such health services is the only option in terms of the insured person’s health condition. Thus, if there is no care for the patient in the Czech Republic that would be covered by health insurance, but such care exists abroad (anywhere), the insured has the right to reimbursement of such care if it is an exceptional case and if there is no other treatment option for the insured. Prior approval of the insurer is required for such reimbursement, unless it is emergency care – which the insured person can receive even without prior approval.
If you would like more information in this regard, please do not hesitate to contact us.
This article is for informational purposes only and does not constitute legal advice or guidance for any particular case.