For the purpose of the Patient Mobility Directive, the following conditions shall be considered with regard to the possible reimbursement of costs.
Table of contents
Cost reimbursement requirements
The commitment to reimburse costs in accordance with Directive 2011/24/EU covers exclusively those health services to which the insured person is entitled under national law. Entitled to reimbursement are only those persons who have received healthcare services in other EU countries against payment (cash, credit card, etc.) of the treatment costs.
To qualify for costreimbursement under the EU patient mobility directive, prior authorisation before undergoing the treatment must be obtained from the Austrian insurance carrier in regard to certain therapies. The respective social health insurance carrier will provide further information.
Under the Directive, the Austrian Social Insurance Institution is not liable to pay any refund, if the requirements for granting prior authorisation for such treatments are not met. In these cases, the treatment costs will thus be entirely borne by the patient.
Level of reimbursement
Basically, the Member State of affiliation shall reimburse the cost of the cross-border healthcare of up to the maximum amounts that would have been accepted, if the healthcare service in question had been provided within its territory. At this, the amount of reimbursement may not exceed the actual costs incurred.
For benefits in kind which are subject to prior authorization, a "special" reimbursement will apply. For all other benefits in kind, 80 percent of the nationally valid contract tariffs will be reimbursed (applies both to benefits provided by the foreign contractual partner and to foreign noncontractual partners).
You can find out the amount of the expected coverage of costs from your social insurance fund.
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.
Exception “Medical emergency“
The costs of unplanned health services received abroad can only be invoiced in emergencies by contractual partners under Regulation (EC) No 883/2004 and Regulation (EC) No 987/2009. In the case of non-contractual partners, reimbursement can only be applied for retrospectively via the 2011/24/EU Directive. For more information, see “ Medical emergencies”.
Contact information of social insurance carriers
The used references can be found in the List of sources.
Last update: 19 July 2019
Created by: Redaktion Gesundheitsportal