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What rights does my patient have?

The entitlements and bill settlement methods depend largely, and firstly, on the legal entitlements on the basis of which the treatment is provided, and secondly on the reason for the stay in Germany. The information below will provide you with an overview of the best thing to do for this group of patients in a variety of situations.

Entitlements in accordance with the European regulations

You can treat patients who have health insurance in other EU countries on the basis of a variety of legal foundations. One of the legal foundations can be Regulation (EC) No 883/2004. This regulation guarantees to patients from other EU countries an entitlement to be treated as if they had statutory health insurance in Germany. Those concerned document this entitlement by showing a proof of entitlement. An assisting German health insurance fund is also always involved. The latter pays the contract rates agreed by you in the replacement procedure with the Association of Statutory Health Insurance Physicians or Dentists, and then obtains a refund from the foreign health insurance fund for the costs that have been advanced. The German health insurance fund is involved via different procedures, depending on whether the treatment is planned or unplanned. With regard to planned treatment, European form E 112 or S2, and with unplanned treatment the European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC), is used as a proof of entitlement. As a healthcare provider, you can however only settle with an assisting German health insurance fund if you are presented with a valid EHIC or PEB.

If the patient submits other forms to you than the abovementioned European forms, and/or states when completing the Patient’s Declaration or form 81 or 81 K that they are permanently resident in Germany, settlement on the basis of the EHIC or PEB is not possible. Please inform the patient that they need first of all to clarify their insurance status with a health insurance fund in Germany. Until they do, they are a private patient.

Entitlement under the Patient Mobility Directive

Another legal foundation may emerge from the Patient Mobility Directive, which came into force in October 2013. Patients who come to you within this directive do not bring any European forms as a proof of entitlement. You are therefore to treat them as private patients. Such patients pay the cost of the treatment themselves. No settlement takes place via an assisting German health insurance fund.

You will find more information here on these topics and on what else needs to be kept in mind:

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