Do you often go abroad? You are en titled to medical assistance under the National He alth Fund. We asked lawyer Piotr Misiorowski from the Rafał Piotr Janiszewski Advisory Office.
Anna Tłustochowicz: When will the National He alth Fund finance our treatment abroad?
Piotr Misiorowski:In two cases: when unplanned treatment is necessary, while we are temporarily staying in the European Union or EFTA countries, i.e. Norway, Switzerland, Iceland or Liechtenstein, and we have a European He alth Insurance Card. Such a card is easily made in the provincial branch of the National He alth Fund and in an unplanned situation - I emphasize! - NHF treatment will pay for them. In any dimension he deems appropriate.
It sounded scary!
Take it easy. The point is that, in general, when we have an EHIC and we will need hospital treatment, we will, as a rule, be treated there on the same terms as citizens of the country where the treatment will take place. As a rule, Polish tourists who experience even the most popular ski leg fracture do not bear any additional costs. And if they have to pay extra from their own pocket, it is about situations where, in the country where they are on holiday, hospitals apply, for example, to subsidies for meals. They apply to the citizens of a given country, so then also us, but they are not a lot of money.
Sure. And the second case in which the National He alth Fund will pay for our treatment abroad is?
Planned treatment as part of the so-called the Union mechanism for the coordination of social security systems. Here alsofinancing the treatment by the National He alth Fund is possible in two situations : when we cannot - to put it bluntly - wait any longer in the queue to which we were enrolled in Poland, because the state of our he alth deteriorates significantly. The second situation is when we need treatment, which is a guaranteed service in Poland, but currently it is not provided in our country. In both cases, before we go for treatment abroad - of course we are still talking about foreign countries as understood by the European Union and EFTA -we need to obtain approval from the National He alth Fund. In the first case, the consent of the director of the provincial branch of the Fund is sufficient, in the second - the president of the National He alth Fund.
The first case seems clear to me, but the second? What specific treatment may be involved? Very innovative?
Not necessarily. There is no requirement that all guaranteed benefits are provided in Poland. It may happen that this is actually an innovative service, but also obsolete and is no longer being performed.
The key thing is that at the moment no facility in Poland provides such treatment. Then you can apply to the president of the National He alth Fund for the Fund to finance them abroad.
If this benefit is not guaranteed in Poland, but can it save someone's life? If, for example, an oncological patient finds out that in Germany patients are en titled to something that could save him?
Here we unfortunately enter the tough rules of the game! This patient is not a German citizen …
But he is a citizen of the European Union.
Yes, and that is why he has the rights and obligations of a citizen of the Union, but not of any specific EU country! I will give a specific example of the VBT procedure - correction of the spine in children, which is very innovative because it does not require slitting lengthwise and implanting bars. This procedure is reimbursed in Germany, but not in Poland.
And the parent cannot expect the NHF to finance such an operation in Germany for the child?
No, because Polish citizens are not en titled to a German refund.
At this point it may seem that I am simplifying the matter a lot, but it really is: we pay the premium in Poland and we have Polish, not German insurance.
In a situation where a foreign institution opens its branch in Poland?
It happens. Americans do something like that by providing benefits that are included in our list of guaranteed benefits. The money from the National He alth Fund (NFZ) goes to the USA, where the facilities are registered, and then from the USA it returns to the branch in Poland to finance these therapies.
What, for example?
As I said: guaranteed, but the way of describing many guaranteed benefits leaves a lot of room for interpretation. We have, for example, 'prosthetic benefit', right? And there is no detailed description of what this prosthesis must be like in terms of, for example, material or quality. It happens, of course, that an alternative to the prostheses used in our national system is a hyper-modern prosthesis, which is used in America and foreign branches of local institutions offer it, because for them this prosthesis isis the standard. A patient who would like such a better prosthesis asks the President of the National He alth Fund for consent to elective treatment abroad and - if he obtains consent! - the procedure is performed in Poland, but by a foreign facility.
What is the situation when we go abroad to work?
Here I can say a little perversely that such a situation may pay off for a Pole. The key issue is the A1 document that must be downloaded from ZUS.
EU document?
Yes, it can be obtained by any EU citizen in their home country.
We will obtain the A1 document, i.e. the certificate that the employee is insured in Poland, from the Social Insurance Institution.
Possession of such a document is enough for an employee who is posted for a year to work in the aforementioned Germany at that time to have the right to receive the same benefits that result from the insurance that German citizens have. It is similar in every EU country.
It can actually be beneficial.
Well, because if we pay less insurance in Poland than the citizens of, for example, the Netherlands at home - we have the right to local luxuries in he alth care. But this, of course, is related to the fact that we do work in a given EU country.
Sure. Now let us go beyond the Union and EFTA. The NHF will pay for our treatment or not?
It all depends on an international agreement between Poland and a given country. Information about whether such an agreement is functioning can be found on the website of the Ministry of Foreign Affairs in the "Travel information" tab.
Generally, if we think about a long trip outside the European Union and EFTA countries, we must remember about insurance. In our best interest!
In the case of trips with a travel agency, we always take out appropriate insurance, which covers emergency treatment.
In the travel agency, yes. And if we are going on a trip ourselves, what are we supposed to do?
There are many countries that will not allow tourists to enter their territory, unless they can prove that they have insurance. There areemergency he alth policies available on our market, which cover a large catalog of countries.You have to think about it in advance and buy such a policy before leaving. If I used legal language during our conversation, I would say that in this case it is about the so-called principle of due diligence. It is us, potential patients, who must exercise this diligence and take out insurance.
What if we don't? Medical expenses may behorrendous!
If we go abroad without insurance, the National He alth Fund will not finance our treatment for sure. Costs can vary. In less developed countries, it may not be very large, but in highly developed countries - it makes you dizzy. Let's take the USA. Apart from the fact that we will not enter there without proving that we have a policy - even a tourist policy - at all, the bills issued by hospitals cover everything and can be very high. If a foreign woman gave birth to a child in a Polish hospital and the hospital charged it very cheaply, or even included it in its costs, in the United States a woman would even find a "skin to skin contact" item after a cesarean section on the bill! Better not to risk it.
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