European Health Insurance Card
Back page of e-card replaces external health insurances certificate
Since 2005, the e-card replaces health certificates in Austria. In the future, it should also enable additional services like electronic referrals or e-medication. Even though the e-card is by now widely accepted, some uncertainties, regarding the integrated chip and the data stored on it, still remain.
European Health Insurance Card
The back of the e-card is called "European Health Insurance Card" (EHIC) and replaces the external health insurances certificate (= form E111). Its purpose is to enable you to receive necessary medical treatments during limited stays in another EU Member State, EEA states and in Switzerland. You should therefore always take your e-card with you when you're going abroad.
The thoughts behind this are that you should have the same access to the public health care as the citizens of the relevant country and that you don't have to interrupt your stay due to illness.
The basic precondition is that a medical necessity for the treatment is given. Therapies which can be postponed without any health concerns have to wait until your return or the health insurance will classify it like the visit of an optional physician and the costs will, at best, only be compensated on a pro-rata basis.
Pilot trials to create an Europe-wide electronic system already exist, but for the time being, the EHIC only contents the data imprinted on it. These are: academic degree, name, birth date, personal identification number (= social security number), identification number of the insurer valid on the date of issue (doesn't have to be the same as the one of your current insurance), identification number of the card as well as its expiration date.
The expiration date depends on the duration of your insurance. If it is reached, you will get a new card as long as you are still insured. The EHIC has to be signed by its holder. If the cards holder is under 14 years old, the signature field can be left blank or the accompanying adult signs it.
Where is the EHIC valid?
Belgium, Bulgaria, Denmark, Germany, Estonia, Finland, France, Greece, UK, Ireland, Iceland, Italy, Croatia, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Austria, Poland, Portugal, Romania, Sweden, Switzerland, Slowakia, Slowenia, Spain, Czech Republic, Hungary and Cyprus (the Greek Republic).
With Bosnia Herzegovina, Macedonia, Montenegro, Serbia and Turkey, bilateral agreements exist. For these countries, you have to get an international social security certificate in time before your departure. Employees get those from their employer, others from their insurer (personally or online - www.sozialversicherung.at). In case of need, you have to exchange the international social security certificate against a domestic medical treatment certificate at the insurance company or authority in charge at your holiday destination.
Pay the bill on-site, submit it at home
In all other states, you first have to pay for the medical treatment. You should obtain a detailed and balanced receipt in order to make it transparent which treatments you received and that you paid the stated amount on-site.
When you're back at home, you can submit this receipt at your sickness insurance institution. The refund is calculated according to the Austrian tariffs. It is therefore possible that you will have to bear a differential amount yourself. An additional private travel medical insurance is recommended to avoid such costs.
Using the EHIC
If you need medical treatment in a state that participates in the EHIC system, you should show your card as soon as possible in order to avoid misunderstandings. Panel doctors and hospitals are obliged, due to international agreements, to accept your EHIC and to treat you like a local patient. If there is anything unclear regarding the acceptance of your card, you can call the phone number (service hotline of the Austrian social insurance carrier) imprinted on the green front page of the card.
The situation is different if the doctor or hospital has no agreement with the local social insurance, as it is often the case with hotel doctors. The procedure is similar to visiting an optional physician or private hospital in Austria. You have to pay first and later submit the receipt at your sickness insurance organisation to get a refund (according to the Austrian tariffs).
In this context, the Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger) highly recommends a private travel health insurance, as the compensation of health insurance companies are not always cost-covering due to variing performance evaluations in different countries.
Costs of medication
Regarding the costs of medication, the regulations in the scope of the EHIC are comparable to the situation in Austria. If a panel doctor gives you a prescription, you only have to pay the local prescription fee at the pharmacy. If you got the prescription from an optional doctor, you can request the refund of the costs by submitting the bill to your sickness insurance organisation afterwards (once again, the refund is calculated according to the Austrian tariffs). Just like at home, if you purchase medication without a prescription, you have to bear the costs yourself.
Pregnancy and chronic diseases
During temporary stays abroad, the EHIC covers necessary treatments for pregnant women (including the delivery) as well as for persons with chronic diseases like asthma or diabetes. If you need special medical check-ups on a regular basis, it is recommended to evaluate the possibilities at your destination before the departure and to consult your sickness insurance organisation. If you wish to give birth abroad, prior approval of your sickness insurance organisation is required.
If the EHIC is not accepted
In principle, panel doctors and hospitals in states that are integrated in the EHIC system have to accept the card. Unfortunately, this is not always the case in everyday practice. Research of German insurance organisations showed that every thirteenth patient on vacation receives a private bill instead of treatment similar to a local patient.
Problems often occur off the well-beaten tourist tracks, for example when a doctor, out of ignorance, refuses to accept the card and insists on cash payments. In this case, like in third countries, you have to request a detailed receipt which you can submit at your sickness insurance organisation after your return. As pointed out before, it is recommended to have an additional travel health insurance to avoid costs.
Return transport not covered
The insurance of the EHIC covers medical treatments and the possible transport to a hospital on-site. Not covered are the costs for a transfer transport to another hospital on-site as well as the return transport to your home country. These expenses are only covered by a private insurance.
Scheduled treatment abroad
Besides of help in sudden cases of need, it is also possible to schedule medical treatments in one of the participating countries. It is recommended, but not obligated, to consult your sickness insurance organisation beforehand.
The difference: With the approval of the organisation, you have the guarantee of a full refund. Without the approval, the treatment will be refunded like the visit of an optional doctor and according to the Austrian tariffs. If you plan a treatment at a hospital abroad, the approval of your sickness insurance organisation is indispensable! Only with a positive notification, costs will be settled between the participating social security institutions.
Please note: A treatment abroad can only be approved by your sickness insurance organisation if it is recognized as medical treatment by Austrian law.