(Frequently asked questions)
5. What are the possibilities to undergo kidney transplantation abroad? This is a complicated repeated transplantation that I intend to undergo in the Czech Republic.
You can get treatment in which you are interested in the Czech Republic as a cross-border healthcare. The insured person has right to be reimbursed in tariffs valid in the Slovak Republic for costs of cross- border healthcare provided in another EU Member State by a healthcare provider, regardless the healthcare provider is financed by the public system or not, if the healthcare is among the benefits covered by the public health insurance system in the Slovak Republic. The reimbursement of costs is provided in the amount of the corresponding to payment in the Slovak Republic.
The treatment you are interested in belong to the healthcare that requires prior authorization from the health insurance company concerned, so you have to apply for it before your treatment abroad. The requirements of the application for prior authorization and decision-making process are stipulated in Articles 9f, 10 of the Decree of the Ministry of Health No. 232/2014- (clicks on the nkm portal section: Rights and entitlements of insured person – Slovak legislation), there is also justification for the need to provide cross-border healthcare by Slovak provider in the relevant medical specialization. You can contact health insurance company for more information.
In case you have been given a prior authorization from the competent institution you will pay the costs of the provided healthcare directly to the healthcare provider in another EU Member State.
Subsequently, you are entitled to reimbursement of the costs incurred upon the request for reimbursement submitted to the competent health insurance company. Health insurance company will make the refund in the amount which equals to the average price for the healthcare, rendered abroad, which has been in force at the time of provision of healthcare that the health insurance company has agreed on with its contracting healthcare providers.
To ensure entitlement to reimbursement of costs a request must be sent to the competent health insurance company within six months of the end of provision of cross-border healthcare. An application for reimbursement of healthcare costs must contain the original of document whose text includes confirmation of receipt of a sum, record of treatment, a report on provided healthcare, an original of a document listing provided medical procedures as an invoice, bill for medical procedures and some other documents according to Article 14 of the Decree of the Ministry of Health No..232/2014- (clicks on the nkm portal section: Rights and entitlements of insured person – Slovak legislation). Only your health insurance company can provide you information about amount of reimbursement.
6. I have to undergo a spine surgery due to worsening of my health condition. I have been treated for a long time in Slovakia (neurology, physiotherapy). I would like to undergo surgery in the Czech Republic. Where can I get information about estimated prices in Slovakia that would be reimbursed to me by the health insurance company?
Information about the costs of individual medical treatments (contract prices agreed with healthcare providers) will be provided by your health insurance company where you are public health insured. For information on the terms of payment, please refer to the answers to the previous questions.
7. I am insured with the Slovak health insurance company as an employee. I would like to go to the non-contractual dentist for preventive examination and regular treatment in the Czech Republic because I live near the border area between Slovak and the Czech Republic (it is no contractual health care provider). Is there entitlement to reimbursement of these costs?
You can get dental treatment including preventive care in the Czech Republic as a cross-border healthcare if this health care is covered by public health insurance system in the State you are insured in – i.e. in Slovakia.
The status of the healthcare provider in the Czech Republic is not decisive - the insured person has the right to receive cross-border healthcare by contractual and non-contractual healthcare provider too.
Please note, that a certain type of healthcare (for example in dental surgery) requires the prior authorization by your health insurance company. Without prior authorization it is not possible subsequently to reimburse the costs by the competent health insurance company.
The costs of cross-border healthcare are reimbursed in the amount of the rates of the state of insurance. So there is always some difference between the costs paid and costs reimbursed. For information about reimbursement, please refer to the answers to the previous questions. Information about the amount of reimbursement will be provided by your health insurance company with which you are insured.
8. The dentist applied me a dental all-ceramic crown in Hungary. Then I asked my health insurance company for the reimbursement of cross-border healthcare. I am not satisfied with amount of reimbursement. I consider the amount of reimbursement granted by the health insurance company to be disproportionate. Where and how can I verify the accuracy of the reimbursement amount provided by the health insurance company?
In general, the insured person has right to be reimbursed in tariffs of the Slovak Republic for costs of cross-border healthcare, if the healthcare is among the benefits covered by the public health insurance system.
The amount reimbursed for the costs of cross-border healthcare is defined under the Article 9 (10) of the Law Act No. 580/2004 Z. z. on health insurance and amending Act No. 95/2002 Z. z. on insurance and amending certain acts, as amended (clicks on the nkm portal section: Rights and entitlements of insured person – Slovak legislation), as average price for each medical procedure in force at the time of provision of healthcare that the health insurance company has agreed on with the healthcare providers with whom the health insurance company has a contract for provision of special dental healthcare.
The Health Care Surveillance Authority is not competent to verify the correctness of the amount of cross-border healthcare reimbursement because this is the average reimbursement calculated from the contractual prices of a particular health insurance company with its contracted health care providers in the field of dentistry.
You can contact internal supervision department of your health insurance company if you are not satisfied with reimbursement.
You can ask for protection of your rights in the appropriate Slovak court if you think that your rights in case of cross-border healthcare reimbursement were not respected.
We would like to point out that the reimbursement of dental prostheses from the public health insurance system in the Slovak Republic is limited. The health insurance company only pays for the standard material, which is resin. So you can have doubts about the amount of reimbursement because material used in your case - porcelain, which costs are multiple higher than the standard material.
9. I am insured with the public health insurance system in the Czech Republic, but I intend to be provided with the health care in Slovakia. Please, send me a list of healthcare providers in Slovakia.
The list of health care providers is available on the portal of the National Contact Point for Cross-border Healthcare www.nkm.sk (clicked on the nkm portal section: Healthcare Providers).