Conditions for the reimbursement of costs for the provided cross-border healthcare
Insured persons have the right to be reimbursed for the costs of cross-border health care covered by the Directive, if they paid these costs directly to a healthcare provider in another EU Member State. To ensure entitlement to reimbursement of costs a request must be sent to the competent health insurance company within six months as of the end of provision of cross-border healthcare – i.e. “Application for reimbursement of cross-border healthcare costs”. The form of application is stipulated by Decree of the Ministry of Health No. 232/2014 Z. z.
An application for reimbursement of healthcare costs must contain:
- the original of one of the following types of payment documents:
1. a document from a cash register, a cash receipt or a document whose text includes confirmation of receipt of a sum, in the case of a cash payment, or
2. an original counterfoil for a postal order, a copy of an account statement, the original of a debit order from a bank or branch of a foreign bank or the original of confirmation of a debit from a bank account, in the case a cashless payment
- record of treatment, a report on provided healthcare,
- an original of a document listing provided medical procedures as an invoice, bill for medical procedures, prescription for medicines or medical devices.
A referral for ambulatory specialized healthcare issued by general practitioner or paediatrician is to be enclosed to the application for reimbursement.
If the insured person began to receive healthcare in one calendar year and its provision continued in the next calendar year and the insured person paid the costs, the application for reimbursement of healthcare costs shall be sent to the health insurance company with which the patient was insured when cross-border healthcare was provided.
Insured person who pay for cross-border healthcare at the turn of two calendar years must request documentation of payment for healthcare provided to the end of the first calendar year and separate documentation of payment for healthcare provided from the start of the following calendar year.
Foreign language documents attached to an application for reimbursement of healthcare costs can be accepted without an officially certified translation into the state language.
On receiving an application for reimbursement of healthcare costs, the health insurance company checks the accuracy of the applicant’s personal data in the register of insured persons, including compliance with the duty to pay insurance contributions and other duties relating to insurance payers status.
If the insured person is a debtor according to Section 25a para 1 of the Act No. 580/2004 Z. z. on health insurance and amending Act No. 95/2002 Z. z. on insurance and amending certain acts, as amended (hereinafter “Act No. 580/2004”) the competent health insurance company shall reimburse only costs of the immediate healthcare, except for cases stipulated in Section 9 para 2 of the Act No. 580/2004
The competent health insurance company shall reimburse costs to insured persons for whom an insurance payer status is defined and for whom advance payments of insurance contributions or insurance contributions have been paid for the full insurance period, except for insured persons who are employees for whom advance payments of insurance contributions or insurance contributions were not paid by the employer, or to insured persons who pay outstanding advance payments for insurance contributions or insurance contributions retrospectively.
The health insurance company shall reimburse costs to an applicant within six months as of receiving his/her application for reimbursement of healthcare costs if all conditions for identification of the insurance payer status and for advance payment of insurance contributions are met. The term for reimbursement is counted from the receipt of the application which meets all requirements stipulated by law.
The maximum amount reimbursed in Slovakia for the costs of cross-border healthcare is the average price for each medical procedure in force at the time of provision of healthcare that the health insurance company has agreed on with the healthcare providers with which the health insurance company has a contract for the provision of healthcare, and who provide the same healthcare as that provided to the insured person in another EU Member State. Health insurance company cannot reimburse an insured person more than the actual amount paid for healthcare.