Reimbursement of costs for your medical treatment in the EU

Please be advised that SilaMed's information about the medical treatment in Germany of the foreign patients, reimbursement of costs in the EU as well as the travel insurance for medical treatment are based on the data provided by the official sites of the European Union, European National Contact Points for Cross-Border Healthcare, the European Commission and the German Federal Ministry for Economic Affairs and Energy.

Planning costs for the medical treatment in Germany

To ensure maximum cover, you should check with your health insurance institution before you go to Germany. In general, your health insurance institution will cover your costs only if the law in the EU state where you are insured recognizes the treatment.

Who qualifies for the costs reimbursement?

If you are covered by a legal social security scheme in a member State of the European Economic Area or Switzerland, you may be entitled to have the costs met for treatment in Germany. It does not matter what nationality you have, provided you are legally resident in one of these countries.

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 EU State where you are insured or in Germany 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 for your treatment in Germany, then in principle you are not entitled to the costs of hospital treatment received in another EU State. Non-hospital treatment in Germany will be covered on the terms offered by the EU State where you are insured, without any additional reimbursement if German 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.

Example

Marie is insured in EU country A. She has authorisation for an operation in Germany. The cost of her hospital stay in Germany is €4,000. For similar treatment in EU country A, only €2,800 would be reimbursed, as compared with €3,200 in Germany. Because she got authorisation, Marie will enjoy the same terms as people insured in Germany, meaning that she will be reimbursed €3,200 and will have to pay only the €800 difference.

If, on the other hand, a similar treatment in EU country A is reimbursed at €3,500, Marie will receive not only reimbursement at the rate offered in Germany (€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 Marie 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 Germany where you receive treatment, and if a higher rate is offered in the EU 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 Germany 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 Germany 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.

1. Your health insurer can cover all the cost directly.

This system applies to public health care providers - it may not cover private treatment.

You must ask your insurer for prior authorisation before travelling for treatment. If granted, you will then be provided with the appropriate application form (called an S2 form).

The full cost of your treatment will be covered by your insurer.

Reimbursement will usually be arranged directly between the institutions involved so you won't have to pay for the treatment.

2. You can pay for the treatment yourself and claim reimbursement afterwards:

This option covers all providers, whether public or private.

You will be reimbursed up to the cost of that treatment in your EU home country, but only if that treatment is one you are entitled to at home.

You might still have to apply for prior authorisation - check with your National Contact Point.

Whichever option you choose, your health insurer cannot refuse your request for prior authorisation if:

• the specific treatment you need is not available in your home country, but is covered by your statutory health insurer, and
• you can't get the treatment you need without undue delay in your country.

You can find out more about relevant costs and reimbursements either directly from the healthcare provider or from the National Contact Point of Germany where you want to be treated.

Please note that SilaMed cannot provide any medical advice, diagnosis or treatment, and does not make recommendations in choosing a German medical provider – that is a decision that remains entirely up to you.

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