To ensure maximum cover, you should check with your health insurance institution before you go. In general, your health insurance institution will cover your costs only if the law in the State where you are insured recognises the treatment. For example, the cost of spa cures is covered in some countries but not in others.
Which costs will be covered? What will I have to pay?
If you get authorisation, the cost of treatment (in hospital or not) will be covered at whichever rate is higher – the State where you are insured or the State where you are receiving treatment.
Please note that the entitlement to additional reimbursement is not recognised in the case of Switzerland, whether you are insured in an EEA country and travelling to Switzerland or vice versa.
If you did not get authorisation, then in principle you are not entitled to the costs of hospital treatment received in another State. Non-hospital treatment will be covered on the terms offered by the State where you are insured, without any additional reimbursement if the State of treatment offers a higher rate of reimbursement. Please note that if you do not have authorisation, treatment costs are not covered for EEA nationals in Switzerland or vice versa.
Sophie is insured in country A. She has authorisation for an operation in country B. The cost of her hospital stay in country B is €4 000. For similar treatment in country A, only €2 800 would be reimbursed, as compared with €3 200 in country B.
Because she got authorisation, Sophie will enjoy the same terms as people insured in country B, meaning that she will be reimbursed €3 200 and will have to pay only the €800 difference.
If, on the other hand, similar treatment in country A is reimbursed at €3 500, Sophie will receive not only reimbursement at the rate offered in country B (€3 200), but also additional reimbursement of the difference between the two countries (€3 500-€3 200 =€300). The total amount reimbursed in this case would therefore be €3 500, leaving Sophie only €500 to pay.
Which is the most financially advantageous solution?
In financial terms, your best course of action is to obtain authorisation.
For hospital treatment, your health insurance institution will almost always require you to seek prior authorisation. This authorisation guarantees you reimbursement at the most favourable rate. Your treatment costs will then automatically be reimbursed at the rate offered in the State where you receive treatment, and if a higher rate is offered in the State where you are insured, your insurance will reimburse you the difference. Please note that the entitlement to additional reimbursement is not recognised in relations with Switzerland.
For non-hospital treatment, if you obtain authorisation, the guarantees will be the same. Alternatively, you can travel directly to the country where you want to receive treatment, without getting authorisation, and claim the reimbursement offered by your health insurance institution on your return. If the rate of cover is higher than in the State of treatment, you will be reimbursed at that rate. However, if the rate of cover is higher in the State where you are treated, you will not be entitled to additional reimbursement. Please note that without authorisation, treatment costs are not covered in relations with Switzerland.
Note: there is currently no European definition of "hospital treatment" or "non-hospital treatment". If in doubt, check with your health insurance institution.
Please note that in principle, your treatment costs will be covered only if the law in the State where you are insured covers the treatment. For example, the cost of spa cures is covered in some countries but not in others. Find out from your insurance institution before you travel.
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