Very often, people going to work in one of the EU or EFTA countries are accompanied by the fear that they won’t be able to benefit from medical assistance during their trip. These concerns are unfounded. The legislation provides for several types of documents entitling to use health care services. Below we will explain how the different documents differ from each other and to which health care services they give right.
1. Documents entitling the posted worker to use various health care services in the EU and EFTA countries
The European Health Insurance Card, EHIC for short, constitutes the best-known document entitling to benefit from health care services in the EU and EFTA countries. In addition to it, the following documents give right to use such benefits within the territory of the EU and EFTA:
- the provisional replacement certificate of the European Health Insurance Card;
- the S1 document;
- the DA1 document;
- the E112/S2 form.
2. EHIC card
The EHIC is issued at the request of the person concerned. It’s granted by the competent institution of the country where health insurance contributions are paid. In Poland, NFZ (Narodowy Fundusz Zdrowia – the National Health Fund) constitutes such an institution.
A person who has obtained an EHIC is entitled to necessary medical benefits. At the same time, in practice, the treating physician decides whether a specific service is necessary in a given case.
The EHIC card doesn’t entitle to benefit from scheduled treatment.
Thanks to the EHIC card, it’s possible to use the services offered by the public health service and to the extent that citizens of the country in which you use medical assistance have right. Therefore, this document won’t be helpful if its holder wants to use private health care. She/he will also have to cover the cost of medical services that are payable for citizens of the country where she/he receives treatment.
3. Provisional replacement certificate of the European Health Insurance Card
Persons who didn’t have an EHIC card during their stay in one of the EU or EFTA countries, but who benefited from medical assistance, may apply to the competent institution of the State in which they are entitled to health insurance for a provisional replacement certificate of the European Health Insurance Card. This document confirms the right of the person indicated in it to use health care services during a stay in another EU or EFTA country.
The provisional replacement certificate can be issued retrospectively for the period during which the treatment lasted, i.e. from the moment the entitled person started using health care services until the end of treatment.
The certificate entitles to treatment that is necessary and unscheduled, provided within the public health system of a given State.
4. S1 document
Both the EHIC card and the provisional replacement certificate of the European Health Insurance Card entitle to treatment in a very narrow range. The S1 document gives right to treatment in a much wider scope. It entitles to full treatment, including scheduled one.
A person applying for the S1 document shall fulfil several conditions. First of all, the applicant should have the right to health care services in the country where she/he requests for the issuance of such an document and can’t lose this right due to moving abroad. She/he should also officially change her/his address of residence to a foreign one.
The application for the S1 should be submitted to the competent institution of the country where you have the right to health insurance – in Poland to NFZ. It should be noted here that if NFZ accepts the request and sends a letter to the applicant about granting the document, this means that the document has been sent electronically to the institution indicated in the application.
In order to benefit from treatment abroad, it’s necessary to register the S1 document with the institution of the State to which this certificate was transferred. The procedure for registering the document differs from country to country, because each State determines it independently. However, the catalogue of circumstances when registration of a statement may be refused is common. It’s about:
- the performance of work in the country where the S1 document is to be registered,
- conducting an economic activity in the State where the S1 document is to be registered,
- no confirmation of the applicant’s permanent residence in the country where the S1 document is to be registered,
- the fact that the person indicated as a family member hasn’t fulfilled the conditions to have health insurance.
After registering the S1 certificate, the national document must be picked up. This document must be presented at health care facilities when using health care services.
The S1 document can also be obtained for a family member with whom the entitled person is moving. For this purpose, it’s sufficient for the entitled person to request the registration of the entitlement for a family member when registering the S1 document in the country of residence. However, it should be noted that each of the EU and EFTA States has its own definition of a family member. Thus, it may occur that a given person has the status of a family member entitled to health insurance benefits in one country, but hasn’t it in another State.
5. DA1 document
In order to receive medical care in connection with an accident at work or occupational disease in a country other than the State where health insurance contributions are paid, it’s necessary to have the DA1 document. This document confirms the right to treatment related to an accident at work or occupational disease in countries where the effects of an accident at work or occupational disease are treated under a separate system of care.
To obtain the right to medical benefits, the DA1 document must be submitted to the institution competent for health insurance or to the institution competent for insurance against accidents at work and occupational diseases in the country of residence or stay.
The DA1 document entitles to benefits only to the extent specified by the doctor.
6. E112 form/S2 document
It may occur that it’s advisable to undergo scheduled treatment in a country other than the State where health insurance contributions are paid. In this case, the E112 form/S2 document shall be obtained. The document in question constitutes an individual consent of the competent insitution to cover the cost of scheduled treatment in another country. It entitles to health services of a planned nature, indicated by the institution issuing the authorisation. It’s extremely important to hold it. Indeed, it should be explained that a person without the E112 form/S2 document who receives scheduled treatment in a country other than the State where she/he has health insurance is treated as a private patient. Thus, she/he will have to pay the entire cost of treatment.
In Poland, in order to obtain the E112 form/S2 document, an application must be submitted to the President of NFZ. After an investigation, the President of NFZ issues a decision in the case – he gives or refuses consent for treatment abroad.
It’s necessary to report with the E112 form/S2 document directly to the foreign medical facility where the scheduled treatment is to be carried out.
7. Legal notice
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