Legal framework of cross-border healthcare in Austria
There are various legal frameworks for the provision of cross-border health care services. At EU level, Regulations (EC) No. 883/2004 and No. 987/2009 as well as Directive 2011/24/EU, which was implemented in Austria with the Patient Mobility Act, have been established for this purpose. Further social security regulations apply in Austria.
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Regulation (EC) No. 883/2004
In the application of Regulation (EC) No 883/2004, a distinction is made between unplanned and planned treatment.
Insured persons are entitled to all benefits in kind which become necessary on medical grounds during a temporary stay in the territories of EU Member States, EEA States, and Switzerland, taking into account the nature of the service and the expected length of the stay (“unplanned treatment”). Under the Regulation, contractual doctors and contractual hospitals in these countries are obligated to accept the EHIC ( European Health Insurance Card) and to treat these insured persons as they would national patients. At any rate the costs are settled directly between the foreign and the national insurance providers and the patient is not required to make an advance payment. Also see: Medical emergencies
For a treatment that a patient wishes to receive in another country ("planned treatment"), however, in all cases a patient must request prior authorization from the responsible insurance provider. Any entitlement to specific medical treatment abroad is then issued by the competent insurance institution via form S2. If approval is granted, the patient shall receive the authorized benefits in kind and does not have to pay anything for the treatment by a contractual doctor or in a contractual hospital in the other country, with the possible exception of deductibles or copayments. At any rate the costs are settled directly between the foreign and the national insurance providers and the patient is not required to make an advance payment.
If a prior authorization has not been issued or not been requested, there is no claim for reimbursement of costs afterwards. Nevertheless, the insured person is advised to contact the responsible health insurance fund and have this checked in each individual case.
In the scope of the implementation of Directive 2011/24/EU via the EU Patient Mobility Act, with "planned treatments", that require greater planning, organization and financing for the respective health care system, prior authorization is required for certain treatments in other countries. You can find more detailed information on this under: Prior authorization.
Prior authorization is generally not required for any other medical services. Nevertheless the patient must initially assume the costs of the treatment himself/herself (cash payment), although these costs will be refunded either wholly or in part. The amount of the reimbursement depends upon the type of treatment received and whether or not it was pre-authorized. No more than the costs actually incurred will be refunded, and furthermore there may be substantial differences between the actual level of costs paid and the cost reimbursement granted. As a rule only the services listed in the Austrian catalog of services covered are reimbursable. You can find more detailed information on this under: Cost reimbursement