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Hrvatski Hrvatski HR

4. The refund of costs

The refund of costs for the necessary, or emergency healthcare service

If you are insured under compulsory health insurance with the CHIF, and consider that during the temporary stay in another Member State you have unfoundedly borne the costs of the necessary healthcare service, you have the right to submit a written application for reimbursement of the costs mentioned above.

In the process, based on the request submitted, the CHIF shall carry out proceedings determining whether these healthcare services was necessary and whether there are grounds for reimbursement.

Regulation 883/2004 (Regulation (EC) No 883/2004)

If you have utilised healthcare services in contracted healthcare facilities, or with the contracted physicians in another Member State of the European Union (EU), the European Economic Area countries (EEA - Iceland, Liechtenstein and Norway), Switzerland or the United Kingdom of Great Britain and Northern Ireland (UK) and you were still charged for these healthcare services, the request needs to be submitted to the competent CHIF regional or branch office according to your place of residence. Medical documentation on the services utilised should be attached to the request, alongside the original invoice with your name on it, stipulating which services were rendered and that the cost of it had been covered. In case of the positive ruling, you will be refunded in accordance with the prices valid for insured persons in the Member state in which you have utilised healthcare.

Directive 2011/24/EU (Directive 2011/24/EU)

In the event that you have utilised necessary healthcare service at private healthcare providers in another Member State of the EU/EEA, you also entitled to submit a request for the reimbursement of costs, as described earlier (by attaching medical documentation and invoice). But in the case of a positive ruling, you will be entitled to a refund that does not exceed the cost of the equivalent service in Croatia.

The right to reimbursement for the necessary health care services provided in Switzerland and the UK, shall be granted only if you have received the service in contracted healthcare institutions, or contracted physicians, seeing as how Switzerland and the UK are exempted from the scope of the application of the Directive 2011/24/EU.

Time limits for rendering decisions

According to the Article 101 of General Administrative Procedure Act (Official Gazette, no. 47/09 and 110/21), when deciding directly upon the request of a party an official person shall render the decision and deliver it to the party without delay and no later than within 30 days following the receipt of an orderly request.

When conducting an inquiry procedure at the request of a party an official person shall render the decision and deliver it to the party within 60 days following the receipt of an orderly request.

When an official person fails to bring the adopt the decision within the prescribed time limit and to deliver it to the party, the party has the right to file an appeal or institute an administrative dispute.