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Entitlements in accordance with Regulation (EC) No 883/2004

You will find information in this section as to what you should bear in mind if your patient has a treatment entitlement on the basis of Regulation (EC) No 883/2004.

What do I have to bear in mind with patients who have a European Health Insurance Card or Provisional Replacement Certificate?

If the patient presents you with a valid European Health Insurance Card and states that they did not plan to enter Germany to undergo medical treatment, you may not as a rule issue a private invoice for the treatment costs. Instead, you must make the same range of benefits available to the patient as to individuals who have statutory health insurance in Germany. This is conditional on the treatment being medically necessary, taking the length of the stay into account. The scope of the benefits provided will therefore frequently go beyond emergency treatment. You can obtain information on the range of benefits, on forms 80/81 (contract-dentist care) and on the "Patient’s Declaration European Health Insurance" (out-patient contract-doctor care, out-patient emergency treatment and in-patient treatment) and on how to bill the costs in the replacement procedure in this case from the Associations of Statutory Health Insurance Physicians, or in the “Leistungserbringer” (healthcare providers) section of the website of the German Liaison Agency Health Insurance – International. The leaflets provided there also contain information for registered doctors on the rescission procedure. The invoice for fees which the patient has paid is to be refunded if a valid Provisional Replacement Certificate is submitted by the end of the quarter after the first time when services were taken up. Rescission will only take place if the European Health Insurance Card is subsequently submitted, and if this takes place on the day of the treatment itself or on the next working day. You will also need to submit the Patient’s Declaration for the patient to complete and sign if you are billing them privately.

What do I have to bear in mind with patients who have a form E 112 or S2?

If the patient presents a form E 112 or S2, then he or she is in Germany for planned treatment. The cost of medical treatment is only covered in the context of the authorisation which it contains, and only as if the patient had statutory health insurance in Germany. If there is no acute urgency, ask the patient to exchange the form E 112 or S2 for a National Entitlement Document from a local health insurance fund.

You will receive further information on this procedure from your Association of Statutory Health Insurance Physicians in the appropriate section of the German Liaison Agency Health Insurance – International.

What do I have to bear in mind with patients who have a form E 106, E 109, E 121 or S1?

It may occur in rare cases that a patient presents you with a form E 106, E 109, E 121 or S1. This group of patients are individuals who have health insurance in another EU country and live in Germany. A typical example would be a cross-border worker who is insured in another EU country because of his or her employment and returns to Germany every day, or at least once per week, or pensioners who are insured in another EU country and return to Germany in old age because of their children.

If you are presented with a form E 106, E 109, E 121 or S1, please inform the patient that this form needs to be submitted to a German health insurance fund of the individual’s choosing. The individuals are then enrolled by the assisting health insurance fund which they have selected, and receive an insurance card which you can use to settle via the normal procedure.

It may be that treatment is required very urgently and that the selected German health insurance fund is unable to issue the insurance card in time. In such cases, the health insurance fund is permitted to issue the individuals with a billing certificate so that the medically-necessary treatment can be carried out, and you can use this to settle your costs.

If the patient does not present a billing certificate and the treatment needs to be carried out urgently, you can initially issue a private invoice to the individual. If the individual presents the billing certificate or the insurance card within a quarter, the costs that have been advanced are to be reimbursed and settled via the health insurance fund selected by the patient at the contract rates.

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