Reimbursement of expenses in EU states
If a person insured by Všeobecná zdravotná poisťovňa (VšZP) receives care in an EU state and presents to the doctor a document by which VšZP confirms their entitlement to healthcare in the state healthcare system – a European Health Insurance Card (EHIC) or a Temporary Replacement Certificate for the EHIC, the provider shall invoice expenses for the provision of health care to our insurer through the liaison bodies for material benefits in the respective countries.
In some cases it may however happen that the insured person will be required to make a cash payment. This occurs most frequently in relation to out-patient care, if the insured person does not present documentation that is valid at the time of treatment or if the patient is treated by a health care provider that is not part of the public health care network. A cash co-payment may also be required, where this is also paid by persons insured in the state where care is provided.
If the insuree pays the health care provider cash for the provision of healthcare, it is essential to obtain the following documents:
- proof of payment,
- a record of care services or a receipt stating the actions carried out and any medicines prescribed.
The originals of these documents should be carefully preserved.
In certain EU member states the insuree may claim a refund(reimbursement) of costs for the provision of health care during their stay by applying to selected health insurance companies (information about the states where this is possible can be found below, in the information on surcharges and fees in individual EU member states).
If the insuree does not take advantage of this option, the may claim reimbursement for cash payments on their return to the Slovak Republic (SR). They shall complete the form Application for reimbursement of cash payments for material benefits provided in the EU (this form can also be found on the website www.vszp.sk in the section For Insurees/Insurance Abroad/Reimbursement of Expenses) and attach to it the following:
- the original proof of payment,
- a record of care services or a receipt listing the actions carried out and any medicines prescribed.
- any other documents that they received.
If the insuree does not pay for the healthcare provided and the provider sends them an invoice or bill for payment, they shall pay these costs and attach proof of payment to the application for reimbursement in the form specified below that is appropriate for the method of payment used :
- a copy of their bank statement,
- debit notice from the bank,
- the original counterfoil for payment by postal order,
- an original document in the text of which the records and confirms acceptance of a cash payment.
The following documents shall not be accepted as proof of payment:
- invoice, statement,
- bill for health care listing actions carried out,
- confirmation of the provision of health care listing the actions carried out,
- bankový Príkaz na úhradu alebo Medzinárodný príkaz na úhradu.
Documents in a foreign language that are attached to an application for reimbursement will be accepted without an official translation.
On submission of an application for reimbursement, the branch has the right to check the personal details of the insuree in VšZP's register of insurees, including payments of contributions.
Under Council Regulation (EEC) no. 574/72 an insuree may be reimbursed for expenses incurred in Denmark, Ireland, Lichtenstein, Spain and Great Britain only up to the level of the cost that would be paid for care in the SR.
If the insuree paid an amount equal to or less than EUR 1 000, they can decide how the expenses should be reimbursed. Either the amount applicable in the SR or the amount that the insurer in the EU member state pays (the choice should be stated in the section I agree with the reimbursement in the Application for the Reimbursement of Cash Payment for Material Benefits Provided in the EU).
If the insuree paid more than EUR 1 000 for care, they may be reimbursed only the amount that the insurer pays in the EU member state.
Deductibles will not be reimbursed, however.
Information (surcharges and fees in individual EU member states) provided by the liaison bodies of the members of the EU and EEA:
The cost of repatriation for the insured person to the SR after receiving health care in an EU member state is also exempt from refunding.
If the insuree requests on the form that costs be refunded at the EU level, VšZP will use form E126SK to request from the health insurer in the state where care was provided, a statement of the amount that VšZP may refund to the insuree for the provision of health care. This request shall be sent through the liaison bodies for material benefits in the two states The health insurer will pay this amount when it receives an answer and converts the amount at the exchange rate published in the EU Journal.
Before travelling to the EU, we recommend that you take out commercial health insurance, because even valid proof of the insured person's entitlement will not cover full payment of costs for health care received in the EU in all cases (e.g. if you need repatriation to the SR).