EU, EEA and Switzerland
Scope of application
The Member States of the European Union are responsible for designing their individual social security systems. Due to lack of harmonisation at EU level, it is up to the individual Member States to decide which persons are insured under their respective legal provisions, which services are paid for under which conditions, how such services are calculated and the social insurance contributions to be paid. The Member States, however, are required to respect EU law and especially with regard to the provisions governing free movement of services.
The EU provisions governing the coordination of social security systems define common regulations and principles, which must be observed by all national authorities, social insurance institutions and courts when applying domestic law provisions. This ensures that in cross-border cases (for instance trips to another EU Member State), non-discriminatory access to medical services continues to be guaranteed. Persons who make use of the right to free movement and residence within the European Union may thus not be treated less favourably than someone who has always lived and worked in one and the same EU Member State.
Based on special agreements, these provisions also apply with respect to Switzerland and the EEA Member States who are not members of the EU (Norway, Iceland, Liechtenstein).
Medical care when travelling abroad
The European Health Insurance Card (EHIC) data is saved on the back of the e-card (the social insurance card issued to by the Austrian social insurance institutions to all persons insured with them). The EHIC replaces the health insurance certificate for use abroad and the “holiday health insurance certificate”. If the person does not hold a valid EHIC or if the EHIC was cancelled because it was registered as stolen, the social insurance institutions will, upon application, issue a Provisional Replacement Certificate for the European Health Insurance Card. When travelling temporarily (on business or on holiday, for instance) to Member States of the European Union (EU), the European Economic Area (EEA) and Switzerland, holders of an EHIC or of a Provisional Replacement Certificate are entitled to essential medical care under the public healthcare system on the same terms and conditions and at the same cost as insured persons of the respective country.
Travelling abroad for the purpose of medical treatment
When a person travels abroad for the purpose of medical treatment, costs will, as a rule, only be covered by the health insurance institution if such medical treatment is included in the catalogue of services in line with the relevant national legal provisions and subject to prior approval from the health insurance institution. In this context, a differentiation has to be made between hospital (i.e. in-patient) and out-patient treatment.
Under Union law, patients may apply to their social insurance institution for approval of in-patient treatment abroad using portable document S2 (former E-form 112). Such approval must not be refused if the treatment applied for is normally available in the Member State in which the patient’s place of residence is located but cannot be provided in time in this specific case. In such cases, the health insurance fund shall be obliged to refund the costs for such treatment to the patient. Costs are reimbursed under the same terms and conditions as in the country in which the treatment has been provided. However, if reimbursement of costs has not been applied for prior to treatment abroad there is no automatic entitlement to such reimbursement. Refund of costs by the health insurance fund can thus not be guaranteed when patients apply for reimbursement of costs subsequent to having undergone treatment abroad.
For outpatient treatment patients may under Union law also apply for reimbursement of costs using portable document S2 (former E-form 112). They may, however, also undergo treatment directly abroad (EU and EEA) without having applied for reimbursement of costs before leaving Austria. In such cases, patients may submit the application for reimbursement of costs upon their return and the terms and conditions governing the respective health insurance fund under national law shall apply. The regulation on refund of costs for planned outpatient treatment without prior approval is, however, not applicable in relation to Switzerland.
Amount of reimbursed costs
In the event of illness suffered during a temporary stay in another Member State of the EU, an EEA Member State or in Switzerland, services that need to be provided immediately from a medical point of view are covered by the healthcare fund. What is decisive in this connection is whether the services provided are urgently needed due to the patient’s state of health. Using their European Health Insurance Card (EHIC), patients have access to healthcare under the same conditions as the nationals of the country they are staying in and may apply for reimbursement of costs. This means that if the treatment required is free of charge to locals, Austrian patients do not have to pay for treatment. If the treatment is subject to payment of costs, patients may apply for reimbursement of costs either locally from the competent national authority or upon their return to Austria from their own national health insurance fund. Expenses will be reimbursed in line with the rules and rates applicable in the country in which the patient underwent treatment. Thus, treatment costs are either fully reimbursed or patients have to pay a contribution in line with the provisions applicable in the respective country. According to their own rules, the national health insurance funds may also reimburse the full amount.
Patients, whose hospital treatment in another EU or EEA Member State has been approved (portable document S2), are entitled to reimbursement of treatment costs at the respective higher standard rate. If the insurance institution in the country the patient is being treated in provides for a higher rate than the insurance institution in the country the patient is insured in, the same conditions shall apply as for insured persons in the country the patient is staying in. However, if the standard rate provided for by the insurance institution in the patient’s home country is higher, the latter shall cover the difference between the rate paid by the insurance institution in the country the patient is being treated in. Thus it is always the cost reimbursement scheme that is more favourable for the patient that shall be applied. The right to additional reimbursement shall, however, not apply in relation to Switzerland.
Patients who failed to seek and obtain prior approval for planned medical treatment abroad may, upon their return, apply for reimbursement of costs from the insurance institution of their home country. In such a case only their home country’s insurance institution’s respective national provisions shall apply, although the insurance institution in the country the patient was treated in may have provided for a higher standard rate. In the case of Switzerland, costs for planned medical treatment that was not previously approved will not be covered.
Further information and a practical overview can be found on the website of the European Commission.
Bosnia-Herzegovina, Montenegro and Turkey
The EHIC is NOT accepted in these countries. When travelling to one of these countries, you still require the bilateral health insurance certificate for use abroad (“holiday health insurance certificate”), which you have to apply for from your employer or your national health insurance fund. As required it may be necessary to have this certificate replaced by a valid treatment certificate issued by the local foreign social insurance institution. In the event of an accident or an acute illness, hospitals and similar facilities often accept the bilateral health insurance certificate for abroad.
In these countries, medical services are provided exclusively under the respective provisions applicable in the host country and not under Austrian provisions. If necessary, it is possible to submit an invoice for medical services provided in one of these countries to the competent Austrian insurance institution and apply for (partial) refund of the treatment costs.
Rest of the world
Currently, costs for medical treatment must be paid in full by the patient. Upon return to Austria it is possible to apply for (partial) refund of the treatment by submitting the detailed invoices to the competent Austrian insurance institution.