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FAQs – Treatment in other EU Member States

Can any person insured in Austria get treatment in another country?

In principle everyone is free to choose which country they would like to be treated in. However, there are statutory regulations (Legal Framework of cross-border healthcare in Austria) as to which treatments and/or costs will be covered by the respective health insurance provider or which treatments require prior authorization. In order for the costs to be reimbursed, citizens should always find out which costs their own health insurance systems will cover before starting the treatment.

How does Patient Mobility Directive 2011/24/EU differ from Regulation (EC) 833/2004?

In Austria there are different legal frameworks on which the subject of cross-border healthcare is based (Legal Framework of cross-border healthcare in Austria).

In the scope of Regulation (EC) 883/2004, the patient must request prior authorization for all treatments which he or she wishes to receive in another country. If such prior authorization is obtained, the patient will receive the approved benefits in kind and does not need to pay anything for the treatment. The costs will be settled directly between the foreign and the domestic insurance providers.

In the scope of Directive 2011/24/EU, prior authorization is only required for certain treatments in another country (Prior authorization). As a rule the patient is entitled to all other medical benefits and services without prior authorization. However, he or she is initially responsible for the costs (cash payment), but will be reimbursed for them either wholly or in part. The reimbursement depends upon the nature of the treatment received and upon whether or not prior authorization was obtained. No more than the actual costs incurred shall be reimbursed. You can find more precise information on this here: Cost reimbursement

What must be considered when seeking prior authorization?

Inpatient treatments as well as outpatient treatments that require the use of highly specialized and cost-intensive medical infrastructure or medical equipment require prior authorization by the health insurance provider in Austria before they are performed in another country, otherwise the expenses cannot be reimbursed. To this end, it is necessary to submit a request, which will be processed by the responsible health insurance provider within two weeks. Very urgent cases are exceptions and the processing times for them will be reduced accordingly. The requirement of obtaining prior authorization does not apply to a medical emergency in a foreign country. You can find more precise information on services that require prior authorization here: Prior authorization.

What are my options if prior authorization is denied?

If the approval was denied or not obtained, you can still submit a request for reimbursement to your respective Austrian health insurance provider. The amount of the reimbursement depends on whether the treatment was an inpatient or an outpatient treatment. You can find more precise information here: Member State of affiliation – Cost reimbursement
 
You also have the option of appealing a decision of the social security provider and contesting the ruling in court. You can find more detailed information on this here:

What expenses will be reimbursed for a treatment in another country?

Only those health services to which the insured person is entitled under Austrian regulations are reimbursable. The amount of the reimbursement is governed by the level of costs that would have been incurred had a comparable treatment been provided in Austria, without exceeding the actual costs incurred. Note that prior authorization must be obtained from the Austrian health insurance provider in order to get reimbursed for treatments in other countries in the hospital area and for certain treatments in the private practice area.

Do I have to pay for the treatment in another country myself?

If prior authorization was requested and granted in accordance with Regulation (EC) 883/2004, the costs for the approved benefits in kind will be settled directly between the foreign and the domestic insurance providers.
If a corresponding treatment was received without prior authorization in other EU Member States or in the EEA States Iceland, Liechtenstein, and Norway, then under EU Directive 2011/24/EU and/or the corresponding provisions of social security law the patient himself/herself is responsible for the payment (cash, credit card, etc.) of the costs. The expenses will then be reimbursed retroactively through the competent Austrian insurance provider.

Who provides information on the amount of the reimbursement?

The responsible social security provider can tell you whether treatments are reimbursable under the Directive and if so, which ones and what the amount of the reimbursement will be.

For a treatment in another country, will only the costs of the treatment itself be reimbursed?

All costs that would have been assumed for a comparable treatment in Austria will be reimbursed by the insurance provider. Please consult your social security provider for more precise information on cost reimbursement.

Can I get the medicinal products/medical devices prescribed with an Austrian prescription in another country?

Yes, prescriptions for medicinal products or medical devices made out in Austria can be filled in other EU Member States, subject to the local regulations in effect, as long as certain prerequisites (e.g., the required elements are included in the prescription) are met. You can find more precise information on this here: Member State of affiliation – medicinal products and medical devices

Will I have to pay for the medicinal products/medical devices prescribed in the Austrian prescription myself in another country?

Yes, in another country the patient must pay for the medicinal products himself/herself. Information on reimbursement options can be obtained from the competent health insurance provider.

If I get a treatment in another country, am I entitled to follow-up treatment in Austria?

Yes. As the Member State of affiliation, Austria has to take all measures necessary to ensure the continuity of the treatment. The same prerequisites that apply to a comparable treatment in Austria apply here as well.

How can I find the "right" doctors or hospitals in other countries?

The best way is to get in touch with the national contact point of the country in which you wish to be treated.

zuletzt aktualisiert Last update 25.09.2014
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