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.