Legislation of the European Union regulating the rights and entitlements of insured persons
Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems and Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems (hereinafter the “Coordination Regulations”)
Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare (hereinafter only the “Directive”)
Conditions for application of the Directive:
a) nationals of EU Member States,
b) stateless persons and refugees, if they have residence in an EU Member State,
c) nationals of third countries,
d) family members and survivors of persons falling under points a), b) and c) regardless of nationality,
e) inactive persons, if they have residence in an EU Member State.
The benefit of the Directive is that it allows an insured person to choose a provider of cross-border healthcare regardless the provider has a contractual relationship with a particular health insurance company or not.
Insured persons can – except in certain cases defined in legislation of the state concerned – seek out healthcare in another EU Member State without prior authorisation from their health insurance company and can also require for reimbursement of their costs.
The Directive applies to the provision of healthcare to patients regardless of its organisation, method of provision or financing. The condition is that healthcare must be of the type that is paid for in the State where the patient is insured (State of affiliation), i.e. covered by public health insurance and satisfying other statutory conditions for the reimbursement of expenses in the State where the patient is insured.
Cross-border healthcare does not include
a) social services,
b) taking, testing, processing, preservation, storage and distribution of organs, tissues or cells for transplantation,
c) public vaccination programmes against infectious diseases which are exclusively aimed at protecting the health of the population on the territory of a Member State,
d) long-term care benefits.