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Persons living or temporarily staying in Poland and receiving health care benefits may obtain them under two separate legal systems:

Each of these systems is governed by different laws and imposes various obligations on individuals who benefit from these systems. Selecting one of them is at the discretion of the patient. That is why it is a good idea to learn about the rights and obligations imposed on the patients  in connection with the choice they make. Knowledge of the differences in relation to their rights and obligations will allow the patients to benefit fully from their rights.

 

THE COORDINATION SYSTEM

HEALTH CARE UNDER THE CROSS-BORDER DIRECTIVE

LEGAL PROVISIONS

Regulation (EC) No 883/2004 of the European Parliament and of the Council

Regulation (EC) No 987/2009 of the European Parliament and of the Council

Act on health care services financed from public funds

Cross-border Directive

 

EU PATIENTS

Persons entitled to health care benefits under the legislation of an EU/EFTA State who are living or temporarily staying in Poland.

Persons entitled to health care benefits under the legislation of an EU State who are living or temporarily staying in Poland.

SCOPE OF HEALTH CARE BENEFITS IN THE MEMBER STATE OF TREATMENT

BENEFITS NECESSARY on medical grounds, to which patients staying temporarily in Poland are entitled. These are the benefits which do not constitute the purpose of the patient's stay in Poland. They are previously unforeseen and must be provided as a result of:

  • a sudden illness, including unexpected deterioration in chronic disease,
  • an accident, for example a road accident,

Whether a given health care benefit is necessary or not is each time decided upon by the Polish doctor who provides the benefit to the patient.

A FULL RANGE OF BENEFITS can be obtained by patients who reside in Poland in the scope and under conditions regulated by the Polish law.

SCHEDULED TREATMENT

Each treatment which is the purpose of the stay in Poland, which always requires obtaining prior authorisation of the health insurance institution competent for the patient from another EU/EFTA Member State.

BENEFITS RESULTING FROM ACCIDENTS AT WORK OR OCCUPATIONAL DISEASES

Health benefits associated only with treatment of effects of an accident at work or an occupational disease.

www.ekuz.nfz.gov.pl

All health care benefits regardless of whether receiving them is the aim of the patient's visit to Poland or whether the need to receive them occurred already during the stay in Poland.

REQUIRED DOCUMENTS

Pursuant to the EU regulations on coordination of social security systems, the following documents are necessary to confirm entitlement to health care benefits in Poland.

  • European Health Insurance Card (EHIC), and in the absence of an EHIC during the stay in Poland - Provisional Replacement Certificate (PRC).
  • E 112 /S2 form
  • E106/E109/E120/E121/ S1 form and a certification issued on their basis

These are all documents which are required by the legislation of the Member State of insurance to recognise entitlement to reimbursement of costs of treatment provided in Poland.

In particular such documents include prior authorisation obtained in the state of insurance regarding reimbursement of cross-border health care, where the legislation of the state of insurance provides for a system of granting such authorisations in relation to specific health care benefits.

Information about the required documents is provided by the National Contact Point in the state in which the patient is insured for health care benefits

HEALTH CARE FACILITIES AND PHARMACIES

Only those health care facilities which operate under the Polish public health care system and are marked with the NFZ logo.

These are all health care facilities which have the right to conduct medical activity in accordance with the Polish legislation in the framework of the public health system as well as private/commercial entities.

If the health care facility which provided health care benefits to the patient in Poland operates outside the public health care system, the patient may take the advantage of these benefits only under the cross-border directive. In this case it is irrelevant whether or not the patient has a suitable EU document confirming his entitlement to benefits.

WHO BEARS THE COSTS OF HEALTH CARE SERVICES AND WHAT IS THEIR AMOUNT

Costs of health care benefits provided to EU patients in Poland are covered by health insurance institutions in the state of insurance.

The EU Patient incurs the cost of the so-called CO-PAYMENT.

The EU patient is obliged to cover the costs of medical treatment directly in the Polish health care facility in exceptional cases, e.g.:

Ø If at the time of provision of the benefits he does not have (he has forgotten or lost) a document certifying his right to treatment;

Ø if the patient received scheduled treatment in Poland and does not have an E112 form/ S2 document;

Ø if the patient received benefits in a private health facility which does not operate in the framework of the public health care system in Poland;

The EU patient is required to cover the full cost of treatment by paying the invoice received from the Polish health care facility or the pharmacy.

The EU Patient can apply to his health insurance institution for reimbursement of the incurred costs.

Information on the conditions which have to be met in order to obtain reimbursement of expenses and the amount of reimbursement are provided by the competent National Contact Points in other EU countries.

The amount of the reimbursement of treatment provided in Poland to an EU patient is determined by the relevant institution in the state of insurance of the patient.