The European Health Insurance Card and rights in accordance with Directive 2011/24/EU on the application of patient's rights in cross-border healthcare
With the European Health Insurance Card that citizens are entitled to on the basis of compulsory health insurance, it is possible to exercise the right to emergency and necessary health services during a temporary stay abroad, that is in Member States of the European Union, in countries of the European Economic Area, in Switzerland and in other countries that have entered into relevant agreements.
The right to health services abroad can be exercised on the basis of the European Health Insurance Card only in the public healthcare network, and if the services have to be paid for on the spot, a reimbursement of treatment costs is requested later from the home health insurance institute. If during a temporary stay abroad treatment is provided by a private institution, the European Health Insurance Card is not valid and any subsequent claim for reimbursement of treatment costs filed with the home health insurance institute is assessed on the basis of the urgency of the case and taking into consideration the costs of the treatment in question if provided by a public health services provider. It is therefore taken into consideration that health services abroad offered by private providers may cost more than the amount of reimbursement granted at home.
Moreover, certain health services abroad are not necessarily covered by compulsory health insurance, for instance ski rescue services. It is therefore recommended to take out supplementary insurance for skiing and similar activities abroad. This should include medical assistance and cover for costs such as transportation to the nearest hospital, treatment in a hospital or clinic, transportation to the home country, etc. up to the agreed upon insurance sum.
There is a difference between the rights to treatment abroad granted by the European Health Insurance Card and the rights in accordance with Directive 2011/24/EU on the application of patient's rights in cross-border healthcare that Member States had to transpose into their national laws by October 2013.
The objective of the Directive is not to encourage cross-border healthcare, but rather to facilitate access to safe and quality cross-border healthcare if required. Unlike the unplanned resorting to – emergency or necessary – health services during a temporary stay abroad and exercised on the basis of the European Health Insurance Card, the rights in accordance with the Directive apply only in the case of planned treatments, meaning that a prerequisite for using the health services abroad is a previously issued referral or prescription. The novelty of the Directive is that, based on the issued referral or prescription alone, insured persons will be able to decide independently in which Member State of the European Union and with which health service provider they wish to exercise their right to healthcare.
The Directive does not apply to services covered by primary healthcare (such as dental care) and there are certain other restrictions about which consumers can address enquiries to the Health Insurance Institute of Slovenia (ZZZS) or to the National Contact Point (NCP) established for this purpose.
Unlike the existing system, the Directive also includes private health service providers which have not concluded a contract with a public insurance company, but only in Member States of the European Union.
In any case, health service consumers abroad shall first bear their own treatment costs and only later file a request for reimbursement in their home country.