Cross-border health care
The provisions of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare grant the possibility for the people, who have compulsory health insurance (hereinafter – the insured) to receive cross-border health care services in the Member States of the European Union (EU), Iceland, Liechtenstein and Norway.
The patients may choose the provider of health care services in another country (regardless whether the institution is private or public), pay for the services, and apply to the territorial health insurance fund (THIF) regarding compensation of expenses on return to Lithuania.
If you intend to go to a country of the European Union, Iceland, Liechtenstein or Norway to receive cross-border health care services, and you want to know whether the service provided to you is reimbursed from the budget of the Compulsory Health Insurance Fund in Lithuania and what the reimbursement amount is, you can apply for prior-notification by e-mail [email protected].
In your application, please, indicate for which specific health care services (outpatient services, inpatient services, examination, or rehabilitation, etc.) you are planning to go to a foreign country.
Attention: as the United Kingdom exited the EU on 31 January 2020, the provisions of this Directive do not apply to the United Kingdom anymore; therefore, the cross-border health care services received in this country are not compensated.
The legal act that governs compensation of cross-border health care expenses:
The expenses of the insured person for cross-border health care are compensated in the scope and in the procedure applicable for compensation of certain health care expenses in the Republic of Lithuania. The compensated amount cannot exceed factual expenses of the insured person for cross-border health care.
The reimbursable amount is determined according to the appropriate procedure of compensation of healthcare services and/or medicines and/or medical aids and/or medical devices from the Compulsory Health Insurance Fund (CHIF), their reference prices and tariffs valid in the Republic of Lithuania at the time when cross-border healthcare was provided to the insured person.
The expenses of the insured person for cross-border health care are reimbursed if the health care services are provided in the country of medical treatment on the basis of the referral of the doctor from the Lithuanian healthcare institution that has an agreement with the THIF or according to a referral from a doctor of healthcare institution operating in the country of treatment, issued after the insured person received cross-border healthcare according to a doctor’s referral from healthcare institution of the Republic of Lithuania that concluded an agreement with the THIF for the provision of these services and the payment of their costs. Referral is not required if primary health care services are provided in the state of treatment.
The insured person or his/her representative has to submit the following documents to THIF not later than within 1 year after provision of cross-border healthcare:
1. A written application in the established form to reimburse the cross-border health care expenses;
2. Personal identity document showing it directly upon arrival at the THIF or its copy if sending documents by post;
3. Medical documents or their copies, including:
- a copy of the referral (continuous referral) if the specialized outpatient or inpatient healthcare services were provided in the state of treatment;
- copies of documents and prescriptions confirming the prescribing and receipt of the medicines, medical aids and medical devices;
- if medicines or medical aids were prescribed to the insured person in the Republic of Lithuania – copies of prescriptions of form 3 (in exceptional cases), according to which these medical aids or medicines were issued in the state of treatment, except for the cases when the reimbursed medicines or medical aids are purchased according to the electronic prescription issued in the information system of the Electronic Health Services and Cooperation Infrastructure;
4. Financial documents or their copies (invoices, cash receipts, vouchers of cash income, etc.).
Upon receipt of the person’s application to reimburse the cost of cross-border healthcare and other necessary documents, it is checked whether the person was insured by the compulsory health insurance in Lithuania at the time when the cross-border healthcare was received.
If it is learnt that the person was insured with the compulsory health insurance and has submitted all the necessary documents, the application is forwarded to the commission responsible to make the decision on reimbursement of cross-border healthcare expenses.
The following expenses of the insured person for cross-border healthcare shall not be reimbursed from the CHIF budget:
- expenses related to cross-border health care: travel, accommodation, food, transport, translation, currency converting expenses, etc.;
- patient’s fees and co-payments paid to the provider of health care services in the country of medical treatment;
- expenses for healthcare services, medicines, medical devices and medical aids not covered by CHIF budget in Lithuania;
- the costs of social services and services which are not classified as healthcare, distribution and receiving of tissues, cells and (or) organs intended for transplantation, vaccination services provided in accordance with population vaccination programs against infectious diseases.
Last updated: 19-09-2024