Questions and answers on the application of directive No. 2011/24 UE on cross-border healthcare

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To whom does the directive apply?

  • All European Union and European Economic Area citizens and their families.
  • Nationals of other countries residing legally in the 28 EU member States, but not those residing in European Economic Area countries (Iceland, Liechtenstein, and Norway).

What types of care are covered by the directive?

  • all healthcare provided or prescribed in a European member State
  • the prescription and dispensation of medications
  • the prescription of medical devices provided as part of a healthcare service.

However, the following are not covered:

  • long-term care (home care services)
  • organ donations
  • public vaccination campaigns

In which countries does the directive allow me to seek care?

  • The 28 European Union Member States and the European Economic Area countries (Iceland, Lichtenstein, and Norway).

What role does the directive assign to the national contact point?

It provides patients with information on:

  • healthcare quality and safety-related standards and guidelines, including provisions for the oversight of healthcare providers.
  • the healthcare providers who are subject to these provisions
  • healthcare providers' authorization to provide care and any restrictions on their professional practice
  • healthcare facility accessibility for people with disabilities
  • patients' rights with regard to cross-border healthcare, procedures and conditions for exercising these rights, and how healthcare costs are reimbursed.
  • the legal and administrative processes for appeal and redress following the provision of cross-border healthcare
  • the information that must appear on prescriptions for medication or medical devices that are written in another member State
  • the contact information for the member States' national contact points

What healthcare providers can I go to in an EU member State other than France?

  • All public or private healthcare providers, whether or not they are "conventionné" (adhere to a national agreement between practitioners and the social security system), practicing legally in a European Union or European Economic Area (Iceland, Liechtenstein, and Norway) country.

How do I choose a healthcare provider in another country if I plan to seek care there (scheduled care)?

1) If you are covered by the French healthcare system:

  • your regular doctor can also tell you about available care.
  • you can get this information from the national contact point of the country in which you plan to seek care (see online list)

2) If you are covered by another country's healthcare system:

  • you can get this information from your home country's national contact point or from your local health insurance fund (see online list)
  • your regular doctor can also tell you about available care.
  • The website Annuaire santé is a service provided by the French Health Insurance system. You can use this site to do a multi-criteria search (name, specialty, location, type of care) for a healthcare professional (doctor, nurse, pharmacist, etc.) or a healthcare facility (hospital, clinic) authorized to provide care in France. It also lists fees and reimbursement rates for care and services.

What do I need to do before my trip?

  • get a copy of your medical file while you are still in your home country
  • your file will be updated in the member State in which you receive care
  • your home country is required to provide follow-up care when you return home.

Where can I check the applicable quality and safety standards?

1) if you are considering coming to France to seek care:

  • you can check the website scopesante.fr (in French only), which provides quality indicators for each healthcare facility.

2) if you are planning to seek care in another European Union member State:

  • you can get this information from your home country's national contact point or from your local health insurance fund.

Will a prescription for medications or medical devices written in another member State be recognized in France?

  • Pursuant to Directive 2011/24 EU, each member State must determine the rules for writing a cross-border prescription in order to ensure that medications and medical devices are dispensed securely and that the prescription is clearly understood by the health professional in the other country. Furthermore, the enforcement directive 2012/52 EU establishes a minimum set of information that must appear on all cross-border prescriptions.
  • if the prescription is written outside of France, you can check with the other country's national contact point for information on the provisions applicable in that member.
  • the health professional writing the prescription must be licensed to prescribe in his/her home member State.

Will a prescription for medication or medical devices written in France be recognized in another member State?

A prescription written in France must include the following information:

  • The patient's identity: Last name, first name, sex and birthdate, weight and height if necessary.
  • The prescribing doctor's identity: Last name, first name, capacity, title or specialty where necessary, professional address specifying "France," phone number preceded by country code "33" and email address, prescriber's (hand-written or digital) signature, and date of the prescription.
  • Medications: Common denomination of the product, i.e. molecule name. The medication must also be identified by its pharmaceutical form, quantity, dosage and usage instructions. If the prescription is for a biological medicinal product, it must also include the brand name of the prescribed drug in addition to the common denomination. If the doctor does not want the medication to be substituted with a generic, the brand may be written on the prescription along with the annotation "no substitutions" and the reason for this request.

The health professional writing the prescription must be licensed to prescribe in his/her home member State.

Make sure to request a prescription in line with these requirements.

Under what circumstances can a prescription for medication or medical devices be declined?

  • the medications or medical devices prescribed do not have market authorization in the State where treatment is being received.
  • the prescribed medications or medical devices do not have market authorization in the other member State
  • the professionals licensed to dispense medical devices or medications consider that filling the prescription is not in your best interests as a patient, or if they have legitimate, justified doubts as to the authenticity or the content of the prescription, or as regards the capacity of the healthcare professional who wrote the prescription.

Are there restrictions on the coverage of healthcare provided within the European Union?

Important: A member State of insurance may require prior authorization for the coverage of certain types of care requiring a hospital stay of at least one night or the use of major medical equipment.

In addition, they may require those insured under other States' healthcare systems to go through the same administrative and regulatory formalities for reimbursement (healthcare pathway, consulting a primary care physician first, getting a medical prescription, etc.)

1) If you are insured in a State other than France:

You will need to get this information from one of the national contact points of the country in which you are insured or from your local health insurance.

2) If you are covered by the French healthcare system:

You will need to apply for prior authorization (S2 form) from your local health insurance fund (CPAM, MSA, RSI etc..) for any of the following types of care:

  • Care requiring a hospital stay of at least one night
  • Care requiring the use of major medical equipment : scintillation camera with or without a positron coincidence detection system, positron emission tomography, positron camera, clinical nuclear magnetic resonance imaging or spectroscopy, CT scanner, hyperbaric chamber, medical cyclotron;
  • Cardiological procedures using medical imaging, via the endovascular route ;
  • Neuroradiology procedures via the endovascular route ;
  • Procedures on the crystalline lens, with or without a vitrectomy ; or any other surgical ophthalmological procedure ;
  • Ambulatory carpal tunnel and other superficial nerve release procedures, as well as other surgical hand procedures;
  • Treatment of chronic renal insufficiency through extrarenal purification ;
  • Cancer treatment ;
  • The examination of a person's genetic characteristics or identification of a person through genetic fingerprints for medical purposes ;
  • Clinical and biological assisted reproductive technology procedures and biological prenatal diagnostics activities. .

However, for all other types of care that do not require prior authorization (S2 form) you will need to follow France's prior authorization procedure for the following care/services:

  • Dentofacial orthopedic treatments,,
  • Massage-physical therapy procedures requiring prior authorization beyond a predetermined number of sessions,
  • Certain laboratory tests and analyses,
  • Certain cholesterol-lowering drugs, certain medical prostheses,
  • Certain medical prostheses,
  • Long-distance transportation (over 150 km), frequent transportation, commercial airline or boat transportation, transportation connected to the care or treatment of children and adolescents enrolled in early-intervention medical-social centers (centres d'action médico-sociale précoce/CAMSP) and medical-psycho-pedagogical centers (centres médico-psycho-pédagogiques/ CMPP).

Before you leave, ask your physician or health professional if prior authorization is required.

Under what circumstances can my request for prior authorization be denied?

  • if the care you intend to receive is not reimbursed by the health care system of the country in which you are insured and is not part of that country's prioritized list of health services.
  • if the care is not appropriate to my state of health
  • if the care can be provided in my country of residence within a reasonable timeframe

How and where do I apply for prior authorization?

1) If you are insured in a country other than France:

You can get this information from your local health insurance fund in your home country.

2) If you are insured in France:

You will need to apply for this document (S2 form) from your local health insurance fund in France, specifying:

  • the type of care you intend to receive as documented by a detailed medical certificate
  • the medical reasons for which you intend to seek care elsewhere in Europe
  • the facility in which you will receive care
  • the expected beginning and end dates of your course of treatment.

You must apply for your authorization far enough in advance so that your local health insurance fund can process it before you leave.

You will receive notice of prior authorization or refusal of coverage from your health insurance fund within 14 days of receipt of your application. If you receive no response within this timeframe, your application has been approved.

To appeal a denial, you may contest the decision before your health insurance fund's arbitration board (commission de recours amiable).

Will I need to pay upfront for the care I receive abroad and then apply for reimbursement?

Under the Directive No. 2011/24 EU, the patient is generally required to pay for healthcare upfront and then apply directly to his/her local health insurance fund in the home member State for reimbursement.

1) If you are covered by a foreign social security system:

your home State's national contact points or your local health insurance fund in your home state can inform you about the applicable reimbursement process.

2) If you are covered by the French social security system:

There are various possible situations:

a) If you have received prior authorization (S2 form) for care subject to prior agreement:

  • you must show this authorization to the facility where you plan to receive care.
  • If a direct settlement system ("tiers payant") is available, the local social security fund will cover your expenses and you will only have to pay any applicable copayment ("ticket modérateur") or out-of-pocket flat fee ("franchise");
  • If you have paid upfront, you will need to submit your paid bill along with your prior authorization to the local health insurance fund in the country where you received care. That fund will reimburse your expenses pursuant to local legislation;
    Important: if you go to a private health care provider or facility that has not signed an agreement with the local social security system, your S2 form will not be recognized. You will need to pay upfront and then submit your paid bills directly to your local health insurance fund in France.
  • if you do not apply for reimbursement in the country where you receive care, or if you receive care from a professional or facility in the private sector, you will need to pay all of your expenses upfront and apply to your local health insurance fund in France when you return home. Your local fund will reimburse you either according to the rates applicable in the country where you received care, or according to French rates.
    Important: if you apply for reimbursement when you return home, you will have to choose between the reimbursement rates applicable in the country in which you received care or those applicable in France. Depending on how much you spent, it is very important to check the rates applicable in each country and to contact the local health insurance funds or national contact points before you make this decision.

b) If you receive ambulatory care not subject to prior authorization:

You will need to pay your expenses upfront and then apply to your local health insurance fund for reimbursement when you return home. Your local sickness fund will reimburse you only according to French rates.

Important: coverage for non-emergency ambulance care is not provided for in the agreements with Switzerland.

What procedures do I follow if I suffer harm from cross-border healthcare?

Important: the applicable law is that of the country in which the care was provided:

1) If the care was provided in France:

Three procedures can be conducted at the same time http://www.sante.gouv.fr/le-guide-pratique.html :

  • Arbitration proceedings: you may request arbitration with the facility, either by applying directly to the hospital's director, or by going through the medical or non-medical ombudsman, or the user relations and quality of care board (Commission des relations avec les usagers et de la qualité de la prise en charge (CRUQPC), by letter specifying your complaints regarding your care. You may be offered a direct transaction with the healthcare facility's insurance company. Under certain conditions, you may also apply to the medical accident arbitration and compensation board (commission de conciliation et d'indemnisation des accidents médicaux (CCI). If the seriousness criteria are met, this board conducts an examination at no cost to the applicant, considering evidence from both parties, to determine the cause-and-effect relationship between the care provided and the harm reported by the patient.
  • Litigation proceedings: proceedings for damages may be brought against the practitioner, either before a civil court if the case involves a physician or other healthcare professional with his/her own practice or a private healthcare facility, or before an administrative court if the case involves a public health facility where the doctor practices, with the patient being considered a public service user.
  • Disciplinary proceedings: You may submit your complaint to the professional association to which the health professional (practicing either in a public facility or in a private practice) belongs in order to bring ethics-related disciplinary proceedings.

2) If the care was provided in another member State:

  • You will need to get this information from the national contact point of the country in which you received care.

How will I be treated if I need emergency care in another country?

  • Always make sure you have a European health insurance card (EHIC) before you go abroad.
  • This card covers all unscheduled (medically necessary) care you may receive during a trip abroad. If you don't have this card and contact the local health insurance fund in the country you are visiting, the foreign health insurance fund may request this document from your local health insurance fund in your home country.
  • If you do not apply for reimbursement of your healthcare expenses in the country you are visiting, you will need to pay upfront and then apply to your local health insurance fund in your home country for reimbursement. Your local health insurance fund in France will reimburse your expenses, using either the reimbursement rates of the country in which you received care or the French reimbursement rates.

Important: if you apply for reimbursement when you return home, you will have to choose between the reimbursement rates applicable in the country in which you received care or those applicable in your home State. Depending on how much you spent, it is very important to check the rates applicable in each country and to contact the local health insurance funds or national contact points before you make this decision.

  • the EHIC also covers care for chronic or preexisting conditions as well as pregnancy and delivery if the purpose of your trip abroad was not to receive care.

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