You are insured in the Netherlands and you want to go to another EU country for treatment. In order to obtain a reimbursement for the costs, you must meet certain conditions. It is therefore important that you always contact your health insurer first. Ask what you need to do to get medical treatment in another EU country. And how you can get a reimbursement.
What should you do?
You should always contact your health insurer first. The health insurer has to inform you about what is the most favourable possibility for you to undergo treatment in another EU country: based on the Regulation or based on the Directive (see below). If you undergo treatment in another EU country based on the Regulation, then you will in any case need your health insurer’s prior permission. Therefore, you need to contact your health insurer well in advance. Your health insurer can inform you about how to submit an application and also has enough time to assess it.
Your health insurer pays the healthcare provider for the treatment
You will receive care in accordance with the rules laid down in European Regulation 883/2004. This means that you usually don't have to pay the costs for the treatment yourself. Your health insurance company does. You must have given prior authorisation for this treatment. In that case, you will receive a document S2.
Treatment according to the legislation
You will receive the treatment in accordance with the legislation of the EU country where you are being treated. Because you are insured in the Netherlands, the health insurer does require that you have a reference letter. Just like in the Netherlands. Because here too, you need it for certain care. For example, for treatment by a medical specialist or in a hospital. You may also need to pay a contribution for the treatment to the healthcare provider.
The National Contact Point for Cross-Border Healthcare (NCP) of the country you want to go to can tell you which healthcare is covered by the statutory health insurance in that country. A list of NCPs can be found on the page 'Other National Contact Points'.
Also, your health insurer usually pays the costs if he has a contract with the foreign healthcare provider.
You first pay for the treatment yourself
According to the European Patients Directive (Directive 2011/24/EU), you can also get a reimbursement for treatment in another EU country. You will first have to pay the costs for the treatment yourself.
You may also need prior authorisation from your health insurance company.
Conditions of your own health insurance
You are entitled to healthcare under the conditions of your own health insurance. Do you meet the conditions? After returning home, you'll declare the costs to your health insurance company. The health insurer reimburses the costs. But only up to the amount that the treatment would have cost if you had had this treatment in the Netherlands.
In most cases, healthcare abroad is so-called 'non-contracted healthcare'. This means that the health insurer has not signed a contract with the healthcare provider. Therefore, the health insurer must let you know in advance how much will be reimbursed.
Are the costs higher than the same treatment would have cost in the Netherlands? Then you usually have to pay the difference yourself. Please check with your health insurance company.
Treatment of rare diseases
Centres of expertise for rare diseases
There are a number of centres of expertise in the European Union for the treatment of rare diseases. Centres of expertise are hospitals where they know a lot about a particular rare disease. Using a search engine on the Orphanet website, you can find designated centres of expertise. Not only in the Netherlands, but also in other countries.
European Reference Networks
European Reference Networks (ERNs) are virtual networks of healthcare providers in Europe. These networks work together to treat complex or rare diseases. These diseases require highly specialised treatments and pooling of knowledge and resources. For a number of diseases there are already ERNs, for example for bone diseases, blood diseases and skin disorders. More ERNs will be established in the course of time. On the website of the European Commission you’ll find extensive information and a list of ERNs.
The European Commission has also produced a flyer. This flyer briefly explains what ERNs are and how they can help you.You’ll find this flyer on the right-hand side of this page under “Documents”.
Prescriptions from another EU country
Did you have treatment in another EU country? Your healthcare provider may have given you a prescription for medicines or medical devices. A Dutch pharmacist or device provider must accept the prescription if it contains the following information:
the patient's details;
details proving that the prescription is genuine;
details about the healthcare provider who wrote the prescription;
Your health insurance company may not allow you to go for treatment to another EU country. Or your health insurer does not reimburse the costs (completely). In that case, ask your health insurance provider to review the decision. Do you not agree with your health insurer's reaction? You can have your difference of opinion (which is called a dispute) assessed by the Dutch Foundation for Health Insurance Complaints and Disputes (SKGZ).
If you think that your health insurer’s reimbursement is too low, you can report this at the NZa. The NZa will then see if your health insurance company has complied with the rules. For more information about the hotline, please visit the website of the NZa (only in Dutch).
Complaints about your treatment in another EU country
Do you have any complaints, for example, about the doctor or the hospital? Or anything else that has to do with that treatment? Please contact the NCP of that country. That NCP has information on how to solve your issue with the doctor or the hospital. But also about how to file a complaint.