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Legal framework of cross-border healthcare in Austria

In the context of Regulation (EC) No. 883/2004 a distinction is made between unplanned and planned treatment.   

Regulation (EC) No. 883/2004

  • Unplanned 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. Also see: Medical emergencies
  • Planned treatment: For a treatment that a patient wishes to receive in another country ("planned treatment"), however, in all cases the patient must request prior authorization from his or her insurance provider. 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.

Directive 2011/24/EU

In the scope of the implementation of Directive 2011/24/EU via the EU Patient Mobility Act, with "planned treatments" 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

Provisions of social security law in Austria

If prior authorization was not granted, not obtained, or not necessary, a claim for reimbursement can be asserted retroactively with the responsible Austrian health insurance provider. Depending upon whether the service was rendered in the hospital area (inpatient area, including treatments rendered by hospital outpatient services) or in the private practice area, different provisions of social security law apply. The cost reimbursement will be 80 percent of the amount that would have been incurred had the service been rendered by a corresponding contractual partner of the Austrian insurance provider.

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