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Whether your health insurer will approve and reimburse travel and accommodation expenses, and if so in what amount, largely depends on whether your health insurance fund has authorised the treatment on a discretionary basis, or whether it was obliged to authorise the treatment. The latter is only the case if the treatment in question is part of the statutory list of benefits in Germany, but cannot be provided to you within a time-limit which is medically justifiable, taking into account your current state of health and the probable course of your illness (see Art. 20(2), sentence 2, of Regulation (EC) 883/04).
In the event that your health insurance fund authorised your treatment on a discretionary basis, any travel and accommodation expense reimbursements are limited to the amount that would have been incurred on the way to the closest hospital in Germany. In this respect, you will be treated as if you had undergone treatment in Germany.
Mr Miller applies to his health insurer to authorise in-patient treatment in France for private reasons. Although the health insurance fund is not obliged to grant authorisation to Mr Miller in this instance, it authorises the treatment requested on a discretionary basis. A patient transport from Germany to France is medically necessary in order to be able to carry out the treatment. The suitable hospital closest to where he lives in Germany is 50 km away. This being so, Mr Miller is only entitled to be reimbursed the cost of patient transport to the closest hospital in Germany (50 km).
The case would be judged differently were treatment not to be available in Germany, or not in good time. In that case, your health insurer will meet the transport expenses from Germany to the place where you receive your treatment if a form E 112 or S2 has been issued for the treatment and the patient transport is medically necessary.
Mr Miller requests authorisation of in-patient treatment in France for a rare disease which can only be provided there within a time-limit which is medically justifiable. Patient transport is also medically necessary for the treatment. In this case, the health insurer is to pay the patient transport costs to France, as the treatment in France is handled as if the treatment were taking place in Germany.
If you are receiving treatment in one of the Member States as if you had private insurance under the Patient Mobility Regulation 2011/24/EU, there is only provision for the health insurer to reimburse the travel and accommodation expenses up to what would have been incurred and refundable in the case of treatment in Germany.
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