Directive No. 2011/24/EU of March 9, 2011 on patients' rights in cross-border healthcare aims to guarantee patient mobility and the free provision of healthcare services.
It aims to facilitate access to safe, high-quality cross-border healthcare and to promote healthcare-related cooperation between EU and EEA (Iceland, Liechtenstein, and Norway) member States.
To whom does the directive apply?
What types of care are covered by the directive?
However, the following are not covered:
In which countries does the directive allow me to seek care?
What role does the directive assign to the national contact point?
It provides patients with information on:
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:
2) If you are covered by another country's healthcare system:
Whom do I contact for information on health care costs abroad?
The healthcare provider you see is required to provide you with clear information on his/her rates.
The national contact point of the country you plan to visit may also be able to provide you with information on applicable healthcare rates https://ec.europa.eu/health/cross_border_care/overview_fr
What to do before leaving, during, and after treatment abroad ?
Before you decide to receive healthcare abroad:
Before you travel abroad for treatment:
During your treatment abroad:
Following treatment abroad:
Before you leave France, it is important that you contact the other country's national contact points and before you come to France, France’s national contact point (email@example.com) to get all the information you need to ensure that your cross-border care goes forward smoothly.
Do I have the right to access my medical file?
Directive 2011/24/EU guarantees each patient the right to obtain a copy of his/her medical file, containing iinformation such as diagnosis, test results, assessments of treatment by the patient’s various health care providers, and information on any treatment or surgery provided.
How do I request a copy of my medical file before I come to France?
Your country’s designated national contact point can provide all the information you need on how to get a copy of your medical file.
If you receive care in France, make sure that the health care provider you see adds to your medical file (diagnosis, test results, treatment results, list of pharmaceuticals administered, post-op results, etc.)
How do I access my medical file in France and request a copy before I leave the country?
You can request access to your medical file, either personally or through your physician, by sending a registered letter to a health care professional or facility.
You are entitled to access your file within a maximum of eight days following your request, and at the earliest following a forty-eight hour waiting period. The maximum turnaround time is two months for medical information that is more than five years old.
You can access your file free of charge if you go in person. If you want photocopies of your information, you cannot be charged more than the cost of photocopying or any postal fees.
Whom do I contact if I am denied access to my medical file in France?
a) denial by a private-practice professional
b) denial by a public or private health care facility:
Cada then has a one-month deadline to notify you of its opinion. If the facility fails to comply with this opinion (continued denial of access), the patient can bring action before the administrative court (« tribunal administratif ») for ultra vires.
What information is included in my French medical file?
If you receive care in another country, make sure that the health care provider you see adds to your medical file (diagnosis, test results, treatment results, list of pharmaceuticals administered, post-op results, etc.)
Where can I check the applicable quality and safety standards?
1) if you are considering coming to France to seek care:
2) if you are planning to seek care in another European Union member State:
Where can I find information on my rights as a patient in another country?
Since cross-border healthcare is provided pursuant to local law in the country of treatment, patients’ rights under that country’s domestic law apply. You have the same rights and privileges in terms of access to health care and treatment as domestic patients: rights to choose your health care provider, to informed consent, to equal treatment, to privacy, to access your medical records, to appeal and receive compensation, and to information on the cost of care.
For France, please refer to the page: Patients’ rights in France.
For other countries: the national contact point of the foreign country in which you receive treatment (list) or the health care provider you have chosen can supply more information on these rights.
Will a prescription for medications or medical devices written in another member State be recognized in France?
Your prescription must contain at least the following information:
Identification of the patient: Last name(s), First name(s), Date of birth
Authentication of the prescription: Date issued
Identification of the healthcare professional issuing the prescription
Last name(s), First name(s), Professional qualifications, Direct contact information (email address and telephone or fax number preceded by international country code)
Professional address (including the name of the Member state), Signature (either handwritten or digital, depending on the chosen prescription format)
Identification of the prescribed pharmaceutical, where applicable: common name, brand name indication, pharmaceutical form (tablet, solution, etc.), quantity, dosage, and directions for use.
Will a prescription for medications or medical devices written in France be recognized in another member State?
A prescription written in France must include the following information:
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?
How do I appeal a denial of prior authorization (S2 form)?
To appeal an administrative decision, you will need to start by filing a submission with your local health insurance fund (CPAM)’s arbitration board (« Commission de recours amiable »/ CRA). (list of France’s local health insurance funds).
If your appeal is denied, you can then bring proceedings before the social security affairs section (« pôle social ») of the district court (« Tribunal Judiciaire »/TJ).
As a last resort, you can appeal to the court of appeals (« Cour d’appel ») and/or to the court of cassation (« Cour de Cassation »).
To appeal a medical decision, you will need to start by asking your local health insurance fund (« Caisse d’Assurance Maladie ») to conduct an expert medical assessment.
Moreover, on France’s Ministry of Justice website, you can search for contact information for each of the courts to which you can appeal by entering the name of the town in which the health insurance fund that denied the S2 form is located.
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, etc..) for any of the following types of care:
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:
Under what circumstances can my request for prior authorization be denied?
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:
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).
How and where do I apply for prior authorization (under French law) ?
Before you leave, you need to inquire whether the care or treatments you plan to receive will require prior authorization from the Health Insurance Fund in order to be covered. If so, prior authorization will be also required for coverage of scheduled care in another State.
Your designated primary care provider must fill out the request for prior authorisation of coverage and give it to you. You must then complete it and send it to the medical Service of your local Health Insurance Fund in France. You must also send the prescription (original or copy) for care or procedures performed by allied health professionals (physical therapists, speech therapists, orthoptists), for travel expenses for medical purposes, for lab exams or for medical equipment along with your application.
You will receive notice of prior authorization or refusal of coverage from your Health Insurance Fund within a period of 15 to 21 days of receipt of your application, depending on the nature of the care. If you receive no response within this timeframe, your application has been approved.
If your request for prior authorization has been denied, the decision must be reasoned and include instructions on the appeals procedure.
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:
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 steps can I take if I am denied care in France?
You can bring proceedings before either:
How do I get reimbursement for care I received outside of France?
You will need to fill out and submit form S3125C to your local health insurance fund along with your paid medical bills and proof of payment to apply for reimbursement of your health care expenses in another country.
You have a two-year deadline in which to apply to your local health insurance fund for reimbursement of your care.
How do I appeal the amount I have been reimbursed by my local fund?
If the amount of your reimbursement is not what you expected, you will you will need to start by filing a submission with your local health insurance fund (CPAM)’s arbitration board (« Commission de recours amiable »/ CRA) (list of France's local insurance funds)
If your appeal is denied, you can then bring proceedings before the the social security affairs section (« pôle social ») of the district court (« Tribunal Judiciaire »/TJ).
As a last resort, you can appeal to the court of appeals (« Cour d’appel ») and/or to the court of cassation (« Cour de Cassation »).
Moreover, on France’s Ministry of Justice website, you can search for contact information for each of the courts to which you can appeal by entering the name of the town in which the health insurance fund to which you belong is located.
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 :
2) If the care was provided in another member State:
How will I be treated if I need emergency care in another country?
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.
Why did the European Commission create the European Reference Networks (ERN)?
The ERNs are being set up under the 2011 Directive on patients' rights in cross-border healthcare and their work stated on 1st march 2017. This Directive also makes it easier for patients to access information on healthcare and thus to increase their treatment options.
Cooperation at EU level makes a real difference to rare diseases patients and their families, as well as the health professionals helping them. No country alone has the knowledge and capacity to treat all types of rare, complex and low-prevalence conditions and diseases, but by cooperating and exchanging life-saving knowledge at European level through ERNs, patients across the EU will have access to the best expertise available.
What are European Reference Networks?
European Reference Networks (ERNs) are networks involving healthcare providers across Europe. They aim to tackle complex or rare diseases and conditions that require highly specialised treatment and a concentration of knowledge and resources. Currently, 24 thematic ERNs are active, involving over 900 medical teams in more than 300 hospitals from 25 EU countries, plus Norway.
The Commission has created the framework for the ERNs and provides grants and technical networking facilities to support network coordinators. However, the driving forces behind the ERNs are healthcare providers and national health authorities.
What medical areas are covered?
The 24 ERNs will work on a wide range of rare diseases. The full list of rare and complex pathologies can be found here: https://ec.europa.eu/health/ern/networks_en
How can the ERNs improve the lives of patients?
Between 6 000 and 8 000 rare diseases affect an estimated 30 million people in the EU. An unfortunate feature of rare diseases and complex conditions is the scarcity and fragmentation of specialist knowledge, which is often not available in the patient's region or country. Many patients therefore do not find a satisfactory explanation for their symptoms or the necessary knowledge on treatment options. By consolidating knowledge and expertise scattered across countries, the ERNs will give healthcare providers access to a much larger pool of expertise. This will result in better chances for patients to receive an accurate diagnosis and advice on the best treatment for their specific condition.
How will the ERNs work in practice?
ERNs are not directly accessible to individual patients. However, with the patients' consent, and in accordance with the rules of their national health system, a patient's case can be referred to the relevant ERN member in their country by their healthcare provider.
To review a patient's diagnosis and treatment, healthcare providers/members of an ERN will consult, exchange information and share knowledge with other members of the network. Coordinators of a specific ERN can convene inter-ERN 'virtual' advisory boards composed of medical specialists across different disciplines. A dedicated IT platform and telemedicine tools can be used for this purpose.
Will the ERNs tackle other diseases or work on other areas of cooperation?
The 24 ERNs currently cover the main clusters of rare, complex and low-prevalence pathologies. In the future, the ERN could possibly be extended to other diseases.
Aside from the diagnosis and treatment of patients, the ERNs will also facilitate research cooperation, joint trainings, knowledge generation, the development of medical guidelines, the facilitation of large clinical studies to improve understanding of diseases, the development of new drugs and medical devices by gathering a large pool of patient data and the development of new care models, eHealth solutions and tools.