Medicines, orthopaedic and other prostheses, dental prostheses
Exercising the right to medicines, orthopaedic and other prostheses, and dental prostheses under Regulation 883/04
On the basis of the EHIC or Substitute Certificate, the persons insured with the CHIF, who during their temporary stay in the territory of another Member State of the EU/EEA/Switzerland, suddenly get ill, hurt or get into an accident shall be entitled to necessary or emergency healthcare, based on the assessment of the contracted physician to whom they turn to for help in that Member state.
Such necessary or emergency healthcare includes the right to medicines, orthopaedic and other prostheses, and dental prostheses, depending on the competent physician’s decision.
Emergency healthcare extends to healthcare services rendered for the treatment of chronic diseases, i.e. existing conditions, providing that the goal of the temporary stay was not to receive treatment for the existing chronic illness.
Exercising the right to medicines, orthopaedic and other prostheses, and dental prostheses, under the Directive 2011/24/EU
Except for the right to medicines as part of receiving necessary, or emergency healthcare based ont he EHIC, in accordance with Regulation 883/04, the right to medicines in another Member State of the EU can be exercised also in accordance with the provisions of the Directive 2011/24/EU and Commission Implementing Directive 2012/52/EU of 20 December 2012 laying down measures to facilitate the recognition of medical prescriptions issued in another Member State (hereinafter: Directive 2012/52/EU).
In accordance with the listed Directives, the insured person in one Member State of the EU has the right to purchase medicines in another Member State based on a prescription received in their home country. Upon returning to their home country, they are entitled to submit to the insurance provider a request for reimbursement of costs for purchased the medicine.
Regarding this, the CHIF has modified prescription forms needed to prescribe the medicines from the CHIF basic and supplementary list of medicines. The said forms are an integral part of the Ordinance on the manner of prescribing and the issuing prescription medicine (Internal consolidated text ).
Modified prescription forms contain new administrative information about the insured person's address and date of birth, and in the upper-right corner contain the information relating to the person who prescribed them (name, address and telephone number of the healthcare institution – private practice in which the medicine had been prescribed).
Persons insured by the CHIF intending to pick up the medicine in another EU Member state are obliged to share this piece of information with their selected primary healthcare physician so that they can issue them a "paper" prescription.
In this case, the selected doctor must include on the prescription form the indication for the medicine prescribed according to their international nonproprietary name – the INN.
You are obliged to cover in full the cost of the medicine dispensed in another Member State based on the prescription mentioned above. The specified obligation covering the cost of medication dispensed in another Member State derives from the provisions of the Directive 2011/24/EU transposed into the Croatian legislation via the Compulsory health insurance Act.
Upon the return to Croatia, you have the right to submit a written request for the reimbursement of costs incurred with the competent CHIF regional or branch office, according to the place of your residence. The request needs to include the invoice for the medicine paid or the certificate on the prescribed medication issued to you by your selected physician in Croatia.
On the basis of a submitted request, providing all of the requirements are met, it is possible you will be granted reimbursement for costs in the amount that the CHIF would pay for that particular medication to a contracted pharmacy in Croatia and in the amount that was set for the medication that is the most similar in shape and packaging included on the CHIF lists of medicines under their nonproprietary name, and which has the lowest price.
Orthopaedic and other prostheses, and dental prostheses
In accordance with the mentioned Directive, you are also entitled to the reimbursement of costs for orthopaedic and other prostheses, and dental prostheses, which have not been granted within the provision of necessary or emergency healthcare based on the EHIC or substitute Certificate in another Member State.
However, you must go through the entire procedure as if you were purchasing the mentioned prostheses at the expense of the CHIF in Croatia.
This means that a competent physician in Croatia needs to prescribe the prostheses using the CHIF forms, or the certificate on orthopedic and other prostheses or the certificate on dental prostheses and, possibly, acquire approval from the CHIF if such approval is needed to exercise rights to specific prosthesis according to Croatian regulations.
On the basis of such a procedure, you are obliged to personally settle the overall cost of prostheses in another Member State, and upon the return to Croatia, you have the right to submit a written request for the reimbursement of costs to the competent CHIF regional or branch office, according to your place of residence. The request needs to include the paid invoice for the orthopaedic or other or dental prostheses, as well as the form issued by the competent physician prescribing the prostheses.
In case of a positive ruling, you will be reimbursed for the cost but it will not exceed the amount that the CHIF would pay for such healthcare service to the contracted healthcare provider in Croatia.