The need to seek medical assistance may also occur during your stay abroad. For the medical services provided, the foreign medical facility may issue a bill which you will be obliged to pay. In this article, we will describe how to obtain reimbursement of treatment costs from NFZ (Narodowy Fundusz Zdrowia – National Health Fund) in EU and EFTA States.
1. Reimbursement of medical expenses
A person who has received a bill for medical services prodived by a foreign medical facility may obtain reimbursement of incurred expenses from NFZ. Reimbursement of treatment costs by NFZ takes place on the basis of an application for the refund of medical expenses. It’s possible to submit the request in question only in the event of fulfilment of the following cumulative conditions:
- the applicant has the right to healthcare benefits in Poland;
- the treatment to which the bill relates took place on the territory of one of the EU or EFTA countries as part of the public healthcare system;
- the treatment was necessary and unplanned, and in the situation where it was planned, NFZ agreed to it;
- the applicant paid the bills form the medical care provided abroad;
- the applicant didn’t receive reimbursement of medical expenses incurred abroad from a private insurance policy.
Reimbursement of costs won’t occur in the event that the applicant has received treatment privately. There is also no entitlement to refund in the situation where the treatment wasn’t considered medically necessary during the stay abroad, even though the applicant benefitted from the public healthcare system. However, it’s possible to request for reimbursement of the costs in question on the basis of Article 42b of the Act of 27 August 2004 on healthcare benefits financed from public funds (i.e. Official Journal of 2024, item 146, as amended).
2. Application for refund of medical expenses
In order to obtain reimbursement of treatment costs in EU and EFTA countries, it’s necessary to complete this document: Application for refund of medical expenses incurred in another UE/EFTA country/the United Kingdom of Great Britain and Northern Ireland (Wniosek o refundację kosztów leczenia poniesionych w innym państwie UE/EFTA/Zjednoczonym Królestwie Wielkiej Brytanii i Irlandii Północnej). The form of the request in question is available on NFZ websites.
The application should include the following information:
- data of the person who received the treatment, including his/her status in NFZ (specify whether he/she is an insured person, an uninsured one with the right to benefits, a family member of an insured person);
- data of the insured person if the applicant is notified as a family member;
- purpose of stay in the country where healthcare services were received;
- date and circumstances of medical treatment;
- data concerning the facility where the medical benefits were used;
- reason for requesting reimbursement of the costs of treatment from NFZ;
- type of treatment expenses (e.g. medicines, hospitalisation, other services);
- preferred method of obtaining refund of medical expenses.
The following documents shall be attached to the application:
- original bill/invoice for medical services provided by a foreign medical facility;
- copies of prescriptions;
- other documents related to the applicant’s treatment;
- confirmation of payment of the bill/invoice.
The medical bill doesn’t have to be paid directly by the applicant. This can be done by any person. However, the payment information shall clearly indicate whose treatment costs the payment concerns.
3. Where to submit the application?
An application for reimbursement of medical expenses shall be addressed to CUW (Centrum Usług Wspólnych – Shared Services Centre) in Gorzów Wielkopolski – Lubuski Oddział Wojewódzki NFZ (Lubuski Regional Branch of the National Health Fund). If the request is submitted to the NFZ Headquarter or to another regional branch of NFZ, it will be forwarded to CUW in Gorzów Wielkobolski – Lubuski Oddział Wojewódzki NFZ.
4. Examination of the application
When examining the request, NFZ first determines whether the applicant was entitled to medical care benefits in Poland at the time of treatment and verifies the completeness of the application. In the event that the applicant hadn’t the right to medical care services in Poland, NFZ will refuse to reimburse the costs. On the other hand, in case of confirmation of the applicant’s right to healthcare, NFZ will contact the insurance institution of the country where the treatment took place to determine the medical expenses. Then, the foreign institution will determine the amount of reimbursement and inform NFZ. Theredore, the value of the refund constitutes the decision of the foreign institution. The amount of the reimbursement can’t be greater thant the costs actually incurred by the applicant and resulting from the attached bills.
NFZ converts the amount indicated by the foreign institution into Polish zloty.
Correspondence between NFZ and foreign institutions is conducted on official forms.
The time taken to examine the application largely depends on the actions of the foreign instution. According to the practice adopted by NFZ, if the foreign institution doesn’t send an answer within 4 months of submitting the request to it, NFZ sends a reminder.
5. Legal notice
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