We explain what needs to be considered when it comes to necessary treatment abroad, which services are covered by health insurance funds, which treatments must be approved separately, and where pitfalls lurk.

Sick on the journey

The statutory health insurance funds cover treatment in the event of an acute illness or accident both in an EU member state and in countries with which a social security agreement exists.

At the hospital or clinic, patients must present the European Health Insurance Card (EHIC) and their identity card. The EHIC is located on the back of the electronic health card. On-site, you fill out a form that entitles you to treatment abroad. The health insurance responsible for your stay abroad will then cover the costs of all services to which a legally insured person is entitled in the respective holiday country. If the doctor or clinic does not accept the EHIC, the patient pays in advance and later submits the invoices and proof of payment for reimbursement. As a rule, the health insurance companies only cover the costs that would also be reimbursed by the funds in the respective country. Persons with statutory health insurance must therefore pay deductibles and co-payments, which are customary abroad, out of their own pocket.

Anyone who travels to countries outside the European Union with which there is no social security agreement, such as the USA or Thailand, will not be reimbursed by the health insurance company for the treatment costs incurred abroad.

Frequently, holidaymakers on site – for example by hotel employees – are recommended pure private doctors or clinics. But be careful: as a rule, you may only use doctors and hospitals who are entitled to care for insured persons in the health insurance system of the country of residence. Who is eligible for this, it is best to research before the trip, as in case of doubt the time or the Internet connection is missing on site.

Abroad for treatment

As a legally insured person, you can also be treated within the European Union. However, anyone who sets out to have their teeth straightened in a neighboring country because it is cheaper there should note the following: Certain services – such as dentures or cures – must, as with treatment in Germany, be approved beforehand by the health insurance company. In the case of dentures, a cost estimate, the so-called treatment, and cost plan must be submitted to the health insurance fund, otherwise, it will not cover the costs. This requirement was confirmed by the Federal Social Court (Az.: B 1 KR 19/08 R) on 30 June 2009. Planned hospital stays – except emergencies – must also always be approved by the competent health insurance fund.

Search for the right doctor

In many cases, health insurance companies can provide information about doctors with whom their insured persons have had positive experiences and offer other helpful information. Doctors or clinics often present their services on the Internet. In addition, the medical services of the automobile clubs are useful sources of information to obtain information about German-language treatment options abroad.

What to clarify before treatment

• Before planning treatment abroad, patients should inform themselves as well as possible about the doctor. In any case, care should be taken in advance of treatment to avoid communication problems with the doctor. If necessary, an interpreter should be consulted.
• Special attention must be paid to the qualification of the doctor and to the quality standards of the clinic or practice. An existing certification according to European standards – such as the ISO mark, which indicates, among other things, the regular monitoring of the practice – can provide an aid for assessment. This also applies to the material used. Here it can also be helpful for patients to inquire about a so-called material passport before creating dentures, which provides information about the material used and the laboratory used.
• The date and course of treatment should be precisely coordinated before treatment – from the duration of the preliminary examination to therapy and follow-up treatment. Because in surgical procedures, for example, regulated aftercare is very important for smooth healing success. The follow-up treatment can take several weeks and make your own treatment costs more expensive. Additional travel costs can be avoided through cooperation partners – such as dentists in private practice – who take over the follow-up treatment in Germany.
• Before treatment, patients should make sure that they are presented with a cost estimate that is as accurate as possible. In order to avoid problems with the later invoice, it is also important that all necessary measures – such as anesthesia or X-ray – are included in the offer of the doctor or clinic.
• German law does not automatically apply. For this purpose, it is essential to conclude a private treatment contract with a foreign doctor and/or other service providers.
• In order for the attending physician to be sufficiently informed and able to plan, it is important that all existing and necessary documents of the patient – such as X-rays and findings – are made available to him in good time.

Frequent treatment abroad

Dentures

For dental prostheses, each insured person generally receives a fixed subsidy from his health insurance fund. This lump sum is the same for all the same dental complaints – such as a missing molar tooth – and regardless of the actual costs incurred by the selected form of restoration, for example, bridge or implant. This rule is also applied to treatment abroad. For patients who want to have their teeth straightened in a neighboring country, it is advisable to first have a treatment and cost plan drawn up by a German dentist. The calculation includes information about the costs due in Germany, in particular: the subsidy from the fund and the co-payment that insured persons have to pay for the chosen care. Thereafter, a treatment and cost plan according to the German model must also be demanded from the selected foreign dentist. This must be submitted to your own health insurance company for approval before treatment. Before that, however, the costs due abroad – including travel and accommodation costs – should be compared with the expenses incurred in Germany for dental prostheses. If problems arise in Germany, there is always an obligation for the treating dentist to repair or – if necessary – to reproduce the dentures. This regulation does not apply to the treatment of German-insured persons abroad, so the rectification should be agreed upon in writing with the foreign dentist. If follow-up treatment is due in Germany, the patient must otherwise bear these costs out of his own pocket.

Cures

Some health insurance companies have concluded contracts with spa facilities in Eastern Europe. Such agreements facilitate direct billing between the competent health insurance fund and the service providers abroad. Patients who are looking for a suitable spa stay should ask their health insurance company whether a special agreement with service providers exists or is planned. Patients can choose whether they want to complete a cure in Germany or in other European countries. However, the benefit must be approved by the health insurance company in any case. In addition to the respective special features of the facilities – such as therapy offers – the travel costs should always be compared with the possible savings.

Medicinal products

Medicinal products for personal use may be imported into Germany from the countries of the European Union for three months. However, anyone who buys prescription drugs must expect an additional lump sum and an increased administrative burden in addition to the statutory co-payment. As a result, it is usually not worthwhile to redeem a prescription in a pharmacy in a neighboring EU country. Internet pharmacies from other European countries also offer discounts on prescription drugs. For non-prescription drugs, health insurance companies usually do not cover the costs. There are price differences within the European Union, from which patients can benefit. Medicines from countries outside the EU – for example, Turkey or Thailand – may also only be imported in quantities that correspond to personal needs. In principle, health insurance companies do not cover any costs. In addition, extreme caution is required when buying medicines outside Europe: there is a risk that falsified, unauthorized or incorrectly dosed medicines will be delivered. Further information on bringing medicines from holiday destinations is available from customs: for travel to EU countries as well as for trips to countries outside the EU.

Costs and billing

A planned treatment abroad can be billed in different ways. If you do not obtain approval from the health insurance company before the treatment, it will settle according to the reimbursement procedure. Insured persons must first pay in advance for all costs. Only after completion of the treatment and upon presentation of the invoice for the services provided, the health insurance fund reimburses the costs – but only up to the amount that would have been due in Germany if appropriate treatment had been provided. From its subsidy, the health insurance fund automatically deducts a share of statutory co-payments from patients and an additional item for the increased administrative burden.

• The invoice for submission to the cash desk should be written in German, if necessary in English. Otherwise, patients will have to pay for the translation costs.
• If the bill of the attending physician in the neighboring European country is higher than in Germany, patients have to bear the price difference themselves.
• In the invoice, all treatment items and individual amounts should be broken down in detail.
• In principle, health insurance does not cover any costs for travel and accommodation.

In certain cases, the assumption of costs must be confirmed in advance by the health insurance company. In addition, it is also possible to apply for reimbursement of costs in advance for services that do not require approval. Depending on the legal basis on which the billing is made, insured persons receive the benefits as a benefit in kind or by way of reimbursement of costs, either under foreign or German law. The health insurance company informs insured persons which route is most favorable for them.