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Advantages and disadvantages of the cost reimbursement methods when being treated as if you had statutory or private health insurance in case of unplanned treatment in another EU country

If you need medical treatment during a temporary stay in another EU country, you can take up the benefits using your European Health Insurance Card (as if you had insurance in the treatment state), or privately, for which you will have to pay in advance. We will show you below what the advantages and disadvantages of the various procedures are for you and what you need to bear in mind.

EC Regulation No. 883/2004 (treatment as if you had statutory health insurance in the State of stay)

Advantages Disadvantages
You may receive benefits beyond the range of benefits available in Germany which are however covered by the range of benefits in the country of treatment. The list of benefits of the State of stay may contain fewer benefits than the German list.
As a rule, you will only incur costs in the amount of the co-payments provided for in the country of treatment. The law of the state of stay may provide for co-payments which do not exist in Germany or which would be lower in Germany. The healthcare provider in the other EU country furthermore decides whether the treatment which you would like to undergo is medically necessary, taking the length of your stay into account.
Costs are settled directly between the healthcare provider and the assisting foreign health insurer. You may only consult healthcare providers who are authorized to treat persons with statutory health insurance. Your entitlement is limited to benefits which are included in the statutory list of benefits in the country of treatment.
In cases of medical malpractice, you will be treated like a person insured with statutory insurance in the country of treatment. The German health funds are entitled to support you in cases of malpractice; this possibility does not apply in case of malpractice in the country of treatment.
There are no translation costs for invoices.  
The health insurance fund does not make any deductions from the reimbursement for administrative costs or if no “value-for-money audit” can be carried out. If the European Health Insurance Card was not accepted, so that you subsequently apply to your German health insurance fund for a reimbursement of the costs, you might have to pay any shortfall towards the foreign or German insurance fund rate yourself.

Directive 2011/24/EU (treatment as if you had private health insurance)

Advantages Disadvantages
You may also consult private healthcare providers (e.g. private doctors and hospitals). The costs may exceed the amount that is reimbursed by your health fund in Germany.
The benefits you may receive are not restricted to what is available to persons with statutory health insurance in the country of treatment. You will thus be able to also receive benefits that are covered by the statutory range of benefits in Germany, but not in the country of treatment. You will initially have to pay the costs yourself, and will only subsequently receive a reimbursement of at least a part of the costs. You will initially have to pay the costs yourself, and will only subsequently receive a reimbursement of at least a part of the costs.
There is no need to have the costs authorised in many cases. The prior authorisation can also be issued retrospectively by your German health fund in many cases if your illness prevented you from obtaining it in time. The German health fund fund may require the invoice to be translated at your expense if it was not drawn up in German.
If no prior authorisation is required, healthcare can be taken up quickly. Unless otherwise agreed by contract, liability and warranty claims are exclusively governed by the legislation of the country of treatment, and you need to pursue them before the courts there. The German health funds can’t help you.
  There may be language difficulties. It may be necessary to arrange for a translation of the results of prior examinations from Germany, for instance parts of your medical records and – after the treatment – also the results of your foreign medical files, at your own expense.
   

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Team EU-PATIENTEN.DE

Pennefeldsweg 12 c
53177 Bonn

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+49 228 9530-802/800

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+49 228 9530-801
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