Specialist - consultative healthcare requiring no prior approval

Specialist - consultative healthcare requiring no prior approval

The section "Planned treatment" describes the scenario in which you need to obtain prior approval for receiving treatment.

If, as the person insured with the CHIF, you are utilising specialist-consultative healthcare for which no prior approval is needed, such treatment must be covered by you in full. In such case, you are entitled to submit a written request to the CHIF for a refund of the treatment cost and inquire whether you are entitled to such refund.

You are obliged to enclose the medical documentation on the healthcare services rendered, as well as the original invoice stipulating which services had been rendered and that the invoice had been paid in full.

The request should also contain the documentation proving medical indication for the treatment and the referral form received from the general practitioner in Croatia. This means that this procedure is equal to the one if you are using healthcare services in Croatia.

The request needs to be submitted to the CHIF regional or branch office according to the place of your residence in Croatia. Based on the submitted request and the submitted medical documentation, the CHIF will provide a medical expert report determining whether the established, standard healthcare services under compulsory health insurance in Croatia had been utilised and whether the healthcare services used needed no prior approval from the CHIF. In case of a positive finding, it will be possible to request a refund for the cost in the amount not exceeding the cost of the equivalent healthcare service in Croatia.