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Assumption of costs in case of treatment as if you had statutory health insurance (European Health Insurance Card)

If you need medical benefits during a temporary stay in another EU country and present your European Health Insurance Card or Provisional Replacement Certificate, this enables you to document in the “State of stay” that you would like to be treated as a patient who has statutory health insurance there and that your healthcare insurer will pay the cost.

Proof of entitlement (presentation of a European Health Insurance Card or Provisional Replacement Certificate)

Please present your European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) to the medical professional. The EHIC can generally be found on the rear of your German health insurance card. If that is not the case, you will need to have the EHIC issued by your health insurance fund before leaving home. If you are already in another EU country and do not have an EHIC with you, you should request your health insurance fund to issue you with a Provisional Replacement Certificate (PRC), which foreign healthcare providers can use to bill in exactly the same way as with your EHIC.

The range of benefits available

The EHIC or PRC entitles you to take up all treatment which is medically necessary within the benefits system during a temporary stay in another EU country, taking the length of your intended stay into account. The medical professional decides on the medical necessity. The range of services here is not restricted to emergency treatment only, but can also go beyond this. There is naturally a difference when it comes to deciding on medical necessity regarding whether you are for instance staying in another EU country for two weeks or two years. What is clear is that no one should be forced to terminate their stay early, or to interrupt it or not to go at all because of otherwise not being able to receive medically-necessary treatment in good time. This also applies as a rule if you have a chronic disease or are pregnant.

What benefits can be offered to you via an EHIC or PRC are in line with the statutory range of benefits of the treatment state. If German law provides for the benefit which you are seeking, such as a specific form of treatment, but the law in the treatment state does not, you also cannot receive this treatment there. The fastest way for you to find out what benefits the treatment state provides for persons with statutory health insurance is by enquiring to the local statutory healthcare insurers listed at the end of our Holiday information leaflets or via the National Contact Point there. It may therefore be that you do not receive a benefit in Germany via the EHIC to which you would be entitled in Germany. Using the EHIC can therefore entail either a restriction in an individual case, or it can open up a broader range of treatment. If for instance the law of the treatment state provides for a benefit for persons with statutory health insurance which is unknown under German law, you can nonetheless take up this benefit at the expense of your German health insurance fund.

If you suffer from bad toothache during your summer holiday in Spain, you will go to the local health centre, where you present your EHIC. Treatment is refused because dental treatment is not included in the Spanish list of benefits.

You will now have to go to a private dentist and initially pay the complete bill in advance. Once you have returned to Germany, you can present the invoice to your German health insurance fund and request a cost reimbursement. The fund can reimburse the German health fund rates to you. If you have not purchased travel health insurance before leaving home, you will have to pay the difference yourself as a rule.

Costs and co-payments

Most Member States provide for co-payments to be made by patients for benefits within statutory social insurance. Since the EHIC entitles you to be treated as if you had statutory health insurance in that country, you must pay these in the same amount.

If the medical professional does not accept the EHIC or PRC and you have to pay the invoice in advance yourself, you have the following possibilities as a rule:

  • You can turn to a healthcare insurer there and tell them that your EHIC or PRC was not recognised. You can then claim a reimbursement at the rates that are applicable in the State of stay.
  • You can present the invoice to your German health insurance fund and request a reimbursement at the rates of the State of stay. Your German health insurance fund will enquire of the healthcare insurer of the State of stay as to what the rates are, and then reimburse them to you. This procedure may take quite some time.
  • You can submit the invoice to your German health insurance fund and request a reimbursement of the rates that are applicable in Germany.

The procedure described above with the EHIC or PRC offers you certainty that the lion’s share of the treatment costs will be paid.

You will however need to consider that you may only be treated in the State of stay by healthcare providers who have a contractual relationship with the statutory healthcare insurers there, and may only receive benefits to the extent provided for there.

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Information on treatment in another EU country at a glance