NFZ always reimburses the costs of treatment in EU countries and outside the community, if the patient receives the consent of the National He alth Fund regarding the planned treatment and reimbursement. Free emergency medical assistance is provided upon presentation of the EHIC, but not all treatment costs will be reimbursed by the National He alth Fund.
Scheduled treatment abroad - procedure for submitting an application to the National He alth Fund
According to the practice and recommendations of the National He alth Fund, scheduled treatment requires a documented consent of the National He alth Fund. Otherwise, it will always be at the insured's expense. In order to obtain consent for scheduled treatment or diagnostic tests outside the country, it is necessary to submitapplicationto the President of the National He alth Fund for treatment or diagnostic tests (or their continuation) abroad and to cover the costs transport to the place where services are provided via the appropriate Provincial Department of the National He alth Fund.
Such an application should be submitted to the NFZ facility appropriate for the place of residence of the person concerned. The certificate entitling you to receive planned treatment or diagnostic tests in another country is the "Certificate regarding the retention of the right to currently due benefits under sickness or maternity insurance", the so-calledform E112 , issued by the provincial branch of the National He alth Fund.
The provincial branch of the Fund verifies the application, with particular emphasis on the information on the applicant's entry on the waiting list at the service provider in the country and / or assesses whether a given service cannot be provided in the country. The department may, when requested by the person applying for treatment, send the application together with a copy of the medical documentation in the scope covered by the application to the provincial consultant in the field of medicine appropriate for the requested treatment or diagnostic tests, for an opinion.
The application examination procedure is completed with the issuance of a decision - with the consent or refusal of the President of the Fund. The President of the National He alth Fund, within 5 working days from the date of receipt of the above-mentioned documents, issues a decision on granting or refusing to grant the applicant consent to conduct or continue treatment or diagnostic tests outside the country, andcovering the costs of transport to the place where the services are provided.
He althcare during a tourist trip to EU and EFTA countries
During a temporary stay (e.g. tourist stay) in another EU / EFTA Member State, the insured person (patient) has the right to medical services necessary from the medical point of view. During such a trip, it is worth paying attention to the service provider, i.e. the person to whom the departing person asks for help. The insured person should use he alth services in a facility that has an agreement with a local he alth insurance fund (general insurer, equivalent to the National He alth Fund). Services are provided upon presentation of the European He alth Insurance Card ( EKUZ ); a photo ID is also required to prove your identity.
It is worth knowing that the patientindividual policyprotects the patient against all costs that are not reimbursed, which is always recommended by the National He alth Fund before going abroad. If you do not have an EHIC, you may have to pay for the service out of pocket. On the other hand, the original bills or invoices (stamped, signed and stamped with the facility's stamp) together with the original proofs of payment are the basis for applying for reimbursement to the insurer in the country of stay or to the National He alth Fund after returning to Poland.
The application for reimbursement of medical expensesshould be submitted to the NHF department competent for the place of residence.
Emergency medical assistance abroad
Medical assistance is available primarily to tourists, pensioners, students and employees sent for vocational training:
1) in case of emergency,
2) in the event of an accident,
3) get sick suddenly,
4) sudden deterioration of he alth.
Necessary services abroad are also kidney dialysis and connection to the oxygen apparatus, if they are part of the started, regular and ongoing treatment in the country. In the case of chronic diseases, before leaving, you should contact the institution providing the services in question to be sure that you will receive the benefit. However, if the purpose of the patient's journey to another Member State is to obtain these benefits, then they are treated as scheduled treatment.
What treatment costs are not reimbursed by the National He alth Fund?
The non-reimbursed cost is the patient's own contribution to the cost of treatment - it is valid in most EU / EFTA Member States. The patient pays for the he alth service out of his own pocket.
Co-payment concerns a visit to a family doctor or a specialist, surcharge for prescription drugs, hospital stay - the patient bears hotel and food costs, costs of servicesmedical emergency services provided as a result of practicing extreme sports, as well as, in most cases, the costs of medical transport and costs in private medical facilities that are not accounted for under the general system.
Legal basis:Regulation of the Minister of He alth on the application for treatment or diagnostic tests outside the country and coverage of transport costs (Journal of Laws of 2008 No. 143 item 897)