Planned treatment in EU member states
European Union regulations determine that if a person insured by public (compulsory) health insurance in one member state cannot get the needed healthcare services in the country in which he is covered by compulsory healthcare insurance, then with the prior authorisation of his competent institution (form E112 or portable document S2) he can travel to another country of the European Union, Iceland, Norway, Liechtenstein, or Switzerland and get the appropriate healthcare services in one of these countries.
There is a special Commission at the Ministry of Health of the Republic of Lithuania responsible to for taking decisions on prior authorisation. The National Health Insurance Fund (NHIF) issues the form E112 within 5 days after the Commission has taken positive decision to send the patient for examinations/consultation/treatment/ abroad.
Form E 112 (portable document S2) is a document certifying that the holder is entitled to receive certain state-provided healthcare services in any of the European Union member states, Iceland, Lichtenstein, Norway or Switzerland, under the same conditions and at the same cost (free in some countries) as people insured in that country.
Please note that the NHIF and the Territorial Health Insurance Funds do not accept invoices issued by foreign healthcare providers. The cost of healthcare provided on the basis of form E112 should be covered by the local public health insurance institution of the country providing the services according to its national legislation and rates and the patient should pay co-payments. The patient’s co-payments as well as expenses paid accommodation and transportation expenses will not be reimbursed from the Compulsory Health Insurance Fund’s budget.
So, in order to receive health care abroad on the basis of form E112, first of all you should find out if the public health insurance covers the costs of healthcare you needed as well as if healthcare provider belongs to the country’s national health system.
Who is entitled to receive form E112?
The form E112 is issued by the NHIF for patients insured by the compulsory health insurance in Lithuania who are referred for treatment into other European Union member states, Iceland, Norway, Liechtenstein and Switzerland in accordance to the procedure approved by the Order of the Minister of Health No. V-729 dated 16th August 2010 (Official Gazette, 2010, Nr. 99-5162).
Who is responsible to take the decision on prior authorisation to send the patient for treatment abroad?
The Commission on decisions on patient examination, consultation and treatment abroad, acting at the Ministry of Health of republic of Lithuania is responsible to take the decision on prior authorisation to send the patient for examination, consultation or treatment abroad. The commission notifies the patient about its decision.
The Commission shall take a decision to send the patient to examine, consult and (or) treat abroad after it receives following documents from the university clinics or hospitals running the university clinics:
- Conclusion of doctors consultation justifying the need to send the patient for certain health care services abroad;
- Extract of medical documents;
- Filled-in special form of referral;
- The letter of foreign health care provider confirming that it accepts form E112 and that the services are the subject of legislation of the country of treatment.
What the holder of form E112 should know
You should provide the form E112 together with an identity document to health care institution.
Please note that the form E 112 is not a guarantee letter insuring that the cost of healthcare services will be assumed by the Lithuania compulsory health insurance. In accordance with the regulation (EC) 883/2004 of European Parliament and of the Council the cost of the treatment provided on the basis of form E 112 should be covered by the public health insurance institution of the country providing the services. The form E112 gives you an access to state-provided healthcare under the same conditions and at the same cost as people insured in the country of treatment. You will have to pay the same patient fees or co-payments, if any are approved by the legislation of country providing the healthcare services.
In case you have actually borne the cost of the treatment keep all receipts and any paperwork (make copies if necessary). You may need them if you’ are applying for a refund or reimbursement.
In order to get the refund of your expense turn to the Territorial Health Insurance Fund and provide the following:
- Your identity document;
- The copies of medical documentation, prescription;
- Original document proving that you have covered the cost of healthcare services;
- The filled in application form; an application form will be provided at the Territorial Health Insurance Fund after the examination of the provided documents.
According to the EU legislation the costs shall be reimbursed in accordance with the reimbursement rates administered by the institution of country of treatment. Thereby, please, note that reimbursement may be delayed because of the compensation will be provided only after the information about the reimbursable amount would be receipt from the European country, where healthcare services had been provided.