1. Regulation 883/04
Planned medical treatment according to Regulation 883/04
Mandatory prior approval
Persons insured with the CHIF going for planned medical treatment in the contracted healthcare facility in another Member State of the EU/EEA/Switzerland must beforehand request approval from the CHIF and in accordance with Article 20 paragraph 1 of the Regulation 883/2004.
Request for the issuance of prior approval
A written request for issuing the prior approval shall be submitted at the competent CHIF regional or branch office, according to your place of residence. The request needs include the following:
-medical indication for the solicited treatment (medical history and other medical documentation from which the established indication for the requested healthcare service is evident),
-the scheduled date for the appointment in the contracted healthcare institution or contracted private practice physician or contracted supplier of orthopaedic and other prostheses in the Republic of Croatia, as well as the
-dates available for the appointment, or the possible date of admittance to the contracted healthcare institution or conctracted physician in another Member State of the EU/EEA/Switzerland.
Approval of the planned treatment
Treatment will be granted if it is envisaged within the Croatian system of compulsory health insurance and providing the same treatment cannot be received in the territory of Croatia in medically justified time-limit, taking into account your health condition and the possible course of the disease (Article 20 paragraph 2 of the Regulation 883/04).
Form E112 HR
For the treatment approved in accordance with the Regulation 883/04, the competent CHIF regional or branch office handling your request shall issue the form E112 HR to you ("Certificate of the retention of rights to benefits in kind in case of sickness and maternity"). Based on the mentioned form, you are entitled to utilise healthcare services with the contracted healthcare institution in another Member state of the EU/EEA/Switzerland. In this case, you are obliged to participate in costs of healthcare (pay for participation) for healthcare services utilised on the basis of the E112 HR form, providing it was mandatory for persons insured in the country where you will be undergoing the scheduled treatment.
Cost reimbursement despite the E112 HR form issued
In the event that while undergoing treatment you were in possession of the issued E112 HR form, and yet you were charged for this, you are entitled to submit a written request for the refund of the cost with the CHIF regional or branch office that has issued the E112 form to you (Article 26.B of the Regulation 987/09 ).
The request needs to include the medical documentation on the healthcare services rendered and the original invoice in your name stipulating which healthcare services were rendered to you and proving that the invoice had been paid.
Denying the request
The request for the approval of the planned treatment in another Member state of the EU/EEA/Switzerland may be denied if the Croatian compulsory health insurance system has not made provisions for the said treatment or the treatment can be provided in Croatia within the medically justifiable time-limit.
Leaving for planned treatment without receiving prior approval
If the person chooses to undergo the planned treatment without receiving prior approval for it, the CHIF shall not reimburse them for it.
