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Cross-border healthcare: what to know

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If you are covered by the healthcare service of an EU Member State you can receive treatment in all other EU Member States. The costs of treatment are borne by your national health insurance body.

Coverage of the costs of medical treatment in another EU country is governed by two EU legal instruments which establish two different schemes for cost coverage by your national health service:


  • Direct healthcare: your country’s health service will pay directly the health service of the country where you are treated
  • Indirect healthcare: you can claim reimbursement for the fees you paid upfront for the public healthcare you received in the country of treatment (from public centres or contracted private providers).

The general principles of the two EU key acts may be applied in specific ways in each EU Member State and may be accompanied by additional national rules.

Direct healthcare: The Regulations

The right to direct healthcare is established by EU Regulations on the coordination of social security systems No 883 of 29 April 2004 and No 987 of 16 September 2009. Under these regulations, you can receive treatment in other EU countries, EEA countries and Switzerland under the same conditions as people covered by the health service of the country of treatment.

The healthcare provided by publicly funded facilities or practitioners (through public or contracted private providers) is paid directly by your national health service/health insurance provider (direct healthcare); any co-payment (ticket) is not normally reimbursable. This service does not apply to the healthcare services provided by non-contracted private providers (or to private services offered by contracted providers).

In the case of scheduled treatment, i.e. treatment to be delivered under a specific healthcare plan, hence prescribed in advance, you must obtain prior authorisation from your national health service/health insurance scheme.

Authorisation is subject to two conditions:

  1. The treatment is appropriate and aimed at safeguarding the health of the person concerned
  2. The treatment is among the sickness benefits covered by the national health service/health insurance provider of your home country but it cannot be given in your country within a time limit which is medically justifiable, taking into account your state of health and the probable course of your illness.

This authorisation is granted by issuing a document (S2 form) which must be submitted to the competent health institutions or to the publicly funded health service providers (public facilities or contracted private providers).
Travel expenses may also be covered and, in some cases, the costs of an accompanying person.

With regard to persons with disabilities,  identified in Article 3(3) of Law No 104 of 5 February 1992, requiring neurological rehabilitation, the out-of-hospital living expenses incurred by the patient and any accompanying person - if the patient is a child or is not self-sufficient and the accompanying person has been authorised by the Regional Reference Centre (CRR) - in hotels or facilities connected with the highly specialised healthcare facility, are classified as equivalent to hospital stay, if inpatient stay was not envisaged for the entire referral authorised in accordance with Article 4 of Ministerial Decree of 3 November 1989, with issue of Form S2 for the direct provision of healthcare.

In the case of inpatient treatment, the costs of stay of the accompanying person may be covered, if the hospital abroad certifies the need for the presence of the accompanying person during the patient’s stay.

The contribution is paid by the Regions in varying amounts according to household income, in the manner set out in Article2(1) of the State-Regions Agreement of 6 February 2003.

Direct access to necessary treatment if you are temporarily in the territory of another Member State, taking into account the nature of the benefits and the expected duration of the stay, is ensured by the European Health Insurance Card (EHIC) or its replacement certificate.

You cannot use the EHIC or its replacement certificate to obtain assumption of costs other than medically necessary treatment.

Indirect healthcare: The Directive

Directive 2011/24/EU of 9 March 2011, implemented by Legislative Decree No 38 of 4 March 2014, followed the Social Security Regulations to provide additional opportunities to receive healthcare abroad in EU and EEA countries (Iceland, Norway and Liechtenstein) under the following conditions:

  • under the Directive, you will pay upfront for the treatment abroad, authorised in the cases provided for, and you can subsequently claim reimbursement from your national health service (indirect healthcare)
  • The reimbursable treatment is that provided by the health service to which you belong,  except for long-term care (the purpose of which is to support people in need of assistance in carrying out everyday and routine tasks), and except for access to and the allocation of organs for the purpose of organ transplants and public vaccination programmes against infectious diseases
  • Cross-border healthcare is reimbursed up to the level of costs that would have been assumed had this healthcare been provided in the country of affiliation, without exceeding the actual cost of healthcare received. Where the full cost of cross-border healthcare exceeds the costs of providing healthcare in its territory, the Member State of affiliation may nevertheless decide to reimburse the full cost.

The Member States may limit access to cross-border healthcare to incoming patients based on overriding reasons of general interest, and may limit the application of the rules on reimbursement to outgoing patients.

The Member States may also introduce prior authorisation for cross-border healthcare which:

  • is made subject to planning requirements relating to the object of ensuring sufficient and permanent access to a balanced range of high-quality treatment in the Member State concerned or to the wish to control costs and avoid, as far as possible, any waste of financial, technical and human resources. involves overnight hospital accommodation of the patient in question for at least one night or requires use of highly specialised and cost-intensive medical infrastructure or medical equipment
  • involves treatments presenting a particular risk for the patient or the population
  • is provided by public/private healthcare facilities or contracted healthcare providers that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care.

The Directive provides that, where the conditions laid down in the Regulations are met, the prior authorisation shall be granted pursuant to the Regulations. In any case, the patient may expressly request application of the Directive.

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Date publishing: 18 october 2019 , last update 28 october 2019


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