FAQs – Treatment in other EU Member States

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

If the benefit is claimed as a private patient paying in cash: 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. For this purpose, an application must be submitted to the responsible health insurance fund. 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.

If necessary, we recommend that you first contact the ombudsmen of the respective health insurance fund. You will find the contact details under the following link: www.sozialversicherung.at

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:

• Member State of affiliation – The procedure before the social security provider
• Member State of affiliation – The procedure before the courts

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.

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.

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.

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.

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

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.

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.

The main objective of the European Reference Networks (ERN) is to provide highly specialized healthcare to patients with rare and highly complex diseases in the European Union.

Information on the ERNs can be found on the following page: https://ec.europa.eu/health/ern_en. Additional information is available via: Information flyer for patients and healthcare professionals - European Commission

Informationen zu den ERNs finden Sie auf folgenden Seiten:

• European Reference Networks
• Informationsblatt des Sozialministeriums zu ERNs