- Is every country the same when it comes to cross- border healthcare policy?
- Can I receive funding for treatments not yet available in my own country?
- Will prescriptions given from abroad be valid in my own country?
- What should I consider when applying for prior authorization?
- What constitutes an undue delay?
- Is it possible to get an S2/E112 form without the presence of undue delay?
- I have been given prior authorization and received an S2/E112 form. What now?
- Why can I only receive funding for treatments in Switzerland with an S2/E112 form?
- If I get a treatment in another country, am I entitled to follow-up treatment once I return to my own country?
No. The United Kingdom, for example, is incredible strict when it comes to prior authoriziation compared to a country like the Netherlands. And there are many other differences. Some countries establish undue delay on a case-by-case basis while others use standardized limits to maximum waiting time per treatment. Some countries reimburse faster than others and some reimburse travel costs while others do not. While the general principles are the same, it is clear that no country is identical when it comes to cross-border healthcare.
This is possible under exceptional circumstances. Your insurance-fund will generally try to determine whether this treatment would have been made available to you had it (hypothetically) been available in your home country.
Requests like these are assessed on a case-by-case basis. If your health-insurance provider wants to make things difficult for you, they unfortunately can. They can refuse prior authorization because another equivalent (and in their eyes equally effective) treatment is available in your home country. Therefore, it is always important that you properly prepare your request for prior authorization.
Yes, and vice versa. Keep in mind that not all medications are available everywhere in Europe. You may return from a hospital stay abroad with a prescription for painkillers which turn out to be unavailable in your country.
Provide a comprehensive explanation of your decision to seek cross- border healthcare. This explanation should not only touch on the possible benefits, but also demonstrate that you are aware of and have carefully considered the risks involved. Maybe you can demonstrate the complexity of your case and thus the need for a renowned surgeon with specific expertise abroad. If available, support your explanation with medical literature and papers. A written letter from your GP or foreign specialist can also play a big role. Discuss the legal framework and ask them to phrase matters in a way that is favorable to you.
There is no clear answer to this question. Case law suggest that health insurance funds have to account for the specific circumstances of your situation. They have to consider your current medical condition, the degree of pain, the nature of your disability and your medical history.
In theory, yes. Your health-insurance may grant you the form at its own discretion. The problem is that the S2/E112 route can become quite expensive for them very quickly. They will usually prefer to reimburse you under the European Cross-Border Healthcare Directive.
The instructions on the S2/E112 form are somewhat confusing. The general idea is that you send the form to whatever health-insurance fund you intend on using. Figuring all this out can be quite challenging (especially if you don’t speak the other country’s language). The good news is that in practice, your health-insurance provider (so the hospital or clinic) can often send the form to the appropriate instutions for you.
Switzerland is not an official member of the European Union and is thus unaffected by the Directive. This is also why Switzerland does not have a national contact point.
It is theoretically possible to claim reimbursement through the underlying principes of the Directive by appealing to the caselaw on which the Directive is based. See the ‘Caselaw and Legislation’ page for more information.
Yes, healthcare-providers in your own country are obligated to offer any aftercare or follow-up treatment deemed medically necessary.