Planned treatment in another Member state of the EU/EEA/Switzerland - Introduction
Up until July 1st 2013, persons insured by the Croatian Health Insurance Fund (CHIF) were entitled to be referred to treatment abroad, the cost of which had been borne by the CHIF based on the provisions laid down by national regulations. This right could have been utilised for treatments that could not be performed in the contracted healthcare institutions in Croatia, and that could successfully be provided abroad.
Since the accession of Croatia to the European Union (EU) on July 1st, 2013, except the mentioned right, persons insured by the CHIF are now entitled to receive planned treatment in another EU Member state if it involves treatment that cen be provided by contracted healthcare service providers in the Republic of Croatia, but the insured person cannot receive it in the medically justifiable time-limit, taking into account their medical condition and the probable course of the illness. As of April 12th, 2014 European legal regulations fully apply even in the case of countries belonging to the European economic area (EEA) — Iceland, Liechtenstein and Norway. This means that persons insured by the CHIF are now entitled to receive planned treatment in the mentioned states. As of January 1st, 2017 the same right applies to Switzerland as well.
The right to planned treatment in contracted healthcare facilities in other Member States of the EU/EEA/Switzerland has been granted by the European legal regulations on the coordination of social security systems, i.e. Regulation 883/04 and Regulation 987 /09. These regulations apply directly and in full, and by legal force supersede the national regulations.
On October 25th, 2013, provisions of Articles 26 through 32 of the Croatian Compulsory Health Insurance Act, transposing into the Croatian legislature the provisions of the Directive 2011/24/EU, came into force. In this way, persons insured by the CHIF are entitled to, providing they fulfil all the laid down requirements, to receive planned treatment in another Member state of the EU/EEA in private healthcare providers. The exception is Switzerland because the Directive 2011/24/EU does not apply to receive treatment in Switzerland.
The CHIF shall bear the cost of the healthcare service utilised abroad providing it had been utilised in accordance with the applicable legal regulations.
In accordance with the above-mentioned, planned medical treatment that can be utilised under the Regulation 883/04 and Directive 2011/24/EU refers to treatment that will be carried out by contracted healthcare providers in the Republic of Croatia, but can not be carried out within a medically justified the time-limit, taking into account the current state of health of the insured person and the likely course of their illness.
This should be differed from referring to treatment abroad, as a right has been granted only on the basis of national regulations, in which case it is about the treatment that cannot be provided by contracted healthcare providers in the Republic of Croatia, and can be successfully provided abroad. The process of referring persons insured by the CHIF to treatment abroad is regulated by the provisions of Articles 25 through 34 of the Ordinance on the rights, requirements and manner of utilising cross-border healthcare (Ordinance-internal consolidated text).
All of the above mentioned legal acts are available at CHIF/legal acts